Use of certain drugs for treating nerve root injury

ABSTRACT

The present invention relates to a method for treating nerve disorders in a mammal or a vertebrate by administering a TNF-alpha inhibitor. The invention also relates to the use of a TNF-alpha inhibitor in the preparation of pharmaceutical compositions for the treatment of nerve root injury and other nerve disorders.

This application is a continuation-in-part of U.S. patent application Ser. No. 11/521,093, filed on Sep. 14, 2006, which is a continuation-in-part of U.S. patent application Ser. No. 10/225,237, filed on Aug. 22, 2002, now U.S. Pat. No. 7,115,557, which is a continuation in part of Ser. No. 09/826,893 filed on Apr. 6, 2001, now abandoned, which is a continuation-in-part of U.S. patent application Ser. No. 09/743,852 filed on Jan. 17, 2001, now U.S. Pat. No. 6,649,589, which was a National Stage filing under 35 U.S.C. § 371 of International Application No. PCT/SE99/01671 filed on Sep. 23, 1999 which was published in English on Apr. 6, 2000 and claims benefit of Swedish Application Nos. 9803276-6 and 9803710-4 filed respectively on Sep. 25, 1998 and Oct. 29, 1998. These applications are herein incorporated by reference in their entirety for all purposes.

TECHNICAL FIELD

The present invention relates to a method for treating nerve root injury and other nerve and spinal disorders in a mammal or a vertebrate by administering a TNF-alpha inhibitor. The invention also relates to the use of a TNF-alpha inhibitor in the preparation of pharmaceutical compositions for the treatment of nerve root injury and other nerve and spinal disorders.

The object of the present invention is to obtain an improved possibility to treat nerve disorders, such as nerve root injury induced by disc herniation (e.g., by intervertebral disc herniation), which may turn up, for example, as a radiating pain in the arm or leg (sciatica), as low back pain or as whiplash associated disorder, by blocking disk related cytokines.

The present invention also relates to the use of a TNF-alpha inhibitor in the preparation of pharmaceutical compositions for the treatment of nerve disorders, such as nerve root injury (e.g., induced by intervertebral disc herniation), as well as a method for treating nerve root injury.

Another object of the present invention is to treat nerve root injury induced by nerve and spinal disorders such as disk herniation, which may turn up as radiating pain into the arm or leg (sciatica), low back pain, and whiplash associated disorder, by blocking disk related cytokines.

The methods and pharmaceutical compositions described herein can be used to treat nerve and spinal disorders such as nerve root injuries, a nerve disorder caused by or associated with a herniated disc(s), a nerve disorder involving pain, a nucleus pulposus-induced nerve injury, a spinal cord compression and sciatica.

BACKGROUND OF THE INVENTION

It is established that conditions such as sciatica and low back pain are due to activation and irritation of intraspinal nervous structures by disk derived substances (45, 48, 49). One key substance for inducing such irritation is Tumor Necrosis Factor alpha (TNF or TNF-alpha). TNF is a proinflammatory cytokine that may sensitize a nerve root in a way that when it is simultaneously deformed mechanically, ectopic nerve may be elicited locally and interpreted by the brain as pain in the corresponding dermatome. TNF may also induce a nutritional deficit in the nerve root by increasing the vascular permeability leading to intraneural edema, and by initiating intravascular coagulation by activation of adhesion molecules at the surface of the endothelial cells (48). Both these mechanisms may subsequently lead to a reduced blood flow with a reduced supply of nutrients and elimination of metabolic waist products. This reduction in nutrition may also induce sciatic pain per se. TNF may also induce low back pain due to local irritation of sensory nerve endings at the surface of the intervertebral disk. This may occur when the nucleus pulposus herniates out into the spinal canal and TNF produced and released from the disk cells may reach the nerve endings.

Disk herniation is a troublesome disorder, which can cause pronounced pain and muscle dysfunction, and thereby loss of ability to work. A herniation may occur in any disk in the spine but herniations in the lumbar and the cervical spine are most common. A disk herniation in the cervical spine may induce radiating pain and muscle dysfunction in the arm, which is generally referred to as cervical rhizopathy. Herniation in the lumbar spine may induce radiating pain and muscle dysfunction in the leg. The radiating pain in the leg is generally referred to as sciatica. Disk herniation will cause trouble to a varying degree, and the pain may last for one or two months or in severe cases up to 6 months. The arm or leg pain that can occur as a result of disk herniation can be very intense and may thus affect the individual patient's whole life situation during the sickness period.

U.S. Pat. No. 5,703,092 discloses the use of hydroxamic acid compounds and carbocyclic acids as metalloproteinase and TNF inhibitors, for the treatment of arthritis and other related inflammatory diseases. No use of these compounds for the treatment of nerve root injuries is disclosed or suggested.

U.S. Pat. No. 4,925,833 discloses the use of tetracyclines to enhance bone protein synthesis and treatment of osteoporosis.

U.S. Pat. No. 4,666,897 discloses inhibition of mammalian collagenolytic enzymes by administering tetracyclines. The collagenolytic activity is manifested by excessive bone resorption, periodontal disease, rheumatoid arthritis, ulceration of cornea, or resorption of skin or other connective tissue collagen.

However, neither this nor U.S. Pat. No. 4,925,833 disclose nerve root injury or the treatment thereof.

It has also been disclosed that selective inhibition may be efficient in reducing sciatic pain (32).

Low back pain affects approximately 80% of the population during their lifetime in most countries. Except for being extremely common, it is also one of the most costly disorders for the society. In Sweden alone, low back pain was estimated to cost $320,000,000 in 1997. The major part of the cost relates to indirect costs such as sick-compensation and reduced productivity, and only a minor part is related to direct costs such as medical care and pharmacological substances.

In a minority of the cases (5%), there may be a known cause for the pain such as intra spinal tumors, rheumatic diseases, infections and more. In these cases the treatment may be specifically aimed at the cause. However, in the majority of the cases of low back pain, the cause remains unknown. At present there is no direct way to treat low back pain with an unknown cause and existing treatment modalities only aim at symptomatic relief.

Low Back Pain and Sciatica

It is necessary to make a distinction between low back pain and one specific condition that is often linked to low back pain called “sciatica”. Sciatica refers to radiating pain into the leg according to the dermatomal innervation area of a specific spinal nerve root. The pain in sciatica is distinctly different from that of low back pain. In sciatica, the pain is sharp and intense, often described as “toothache-like”, and radiates down into the lower extremities, below the level of the knee. The experience of the pain is closely related to the dermatomal innervation of one or more lumbar spinal nerve roots. Sciatica is also frequently related to neurological dysfunction in that specific nerve and may be seen as sensory dysfunction, reduced reflexes and reduced muscular strength. The sciatic pain thus seem to be a neuropathic pain, i.e. pain due to nerve injury, induced by sensitized axons in a spinal nerve root at the lumbar spinal level. The pain experienced by the patient as low back pain is more dull and is diffusely located in the lower back. There is never any radiating pain into the leg.

Sciatica is the result of nerve injury, and the cause of sciatica has an anatomical correlate. Since 1934, sciatica is intimately linked to the presence of a herniated intervertebral disc. However, although most patients with sciatica will display a herniated disc at radiological examination, it is surprising that approximately 30% of an adult population at the age of 40-50 years of age with no present or previous sciatica also have disc herniations when assessed by magnetic resonance tomography, so called “silent” disc herniations (8, 9, 10, 75). The presence of silent disc herniations is intriguing to the spine research community and seems to contradict the relationship between disc herniations and sciatica.

Scientific Knowledge of the Pathophysiologic Mechanisms Behind Low Back Pain

It is well known that the outer part of the annulus fibrosus of the intervertebral disc and the posterior longitudinal ligament are innervated by C-fibers. Although there are no nerve fibers in the deeper part of the annulus fibrosus or the nucleus pulposus in normal discs, nerves may reach these parts in degenerated discs through annular tears.

Silent Disc Herniations

As presented earlier, it is known that approximately one-third of a normal adult population who never suffered from sciatica have radiological visible disc herniations. Since the presence of a disc herniation is so intimately linked to the symptom of sciatica this is surprising, and at present there is no valid explanation for this phenomenon. However, “silent” in this regard only implies that the disc herniations did not produce sciatica. One may assume though that they produce other symptoms.

Whiplash and Whiplash Associated Disorders (WAD)

About 10% to 20% of the occupants of a stricken vehicle in rear-end car collisions suffer from whiplash injury. The injury may also occur as a result of other types of accidents, such as train accidents, and sudden retardations. This injury is defined as a non-contact acceleration-deceleration injury to the head-neck system. It is most often caused by a rear-end car collision and there is no direct impact on the neck.

Presenting symptoms usually include neckpain, headaches, disequilibrium, blurred vision, parenthesize, changes in cognition, fatigue, insomnia and hypersensitivity to light and sound. Dizziness described in a variety of terms such as imbalance, light-headedness and vertigo also occurs frequently and these symptoms may be associated with long-term disability.

Although neurologic and orthopedic examinations do not reveal abnormalities in the majority of patients, the characteristics of dizziness due to whiplash can be elucidated by means of ElectroNystagmoGraphic (ENG) evaluation. This examination is a method that is suitable for proving pathology in the oculo-vestibular system of whiplash-patients.

Until recently, the reason for the extent of injury was poorly understood. In addition, due to the legal and insurance issues, the veracity of complaints of neck pain and other symptoms by people who suffer from whiplash is commonly viewed as suspect.

Whiplash injuries can be quite complex and may include a variety of related problems, such as joint dysfunction, and faulty movement patterns, chronic pain and cognitive and higher center dysfunction.

When the cervical spine (neck) is subject to a whiplash injury, there is usually a combination of factors that contribute to the pain. These factors must be addressed individually, while maintaining a “holistic” view of the patient.

The most significant factors may include one or more of the following: joint dysfunction, muscle dysfunction, and faulty movement patterns.

Joint Dysfunction

This occurs when one of the joints in the spine or limbs loses its normal joint play (resiliency and shock absorption). It is detected through motion palpation, a procedure in which the doctor gently moves the joint in different directions and assesses its joint play. When a joint develops dysfunction, its normal range of movement may be affected and it can become painful. In addition, joint dysfunction can lead to a muscle imbalance and muscle pain and a vicious cycle. The loss of joint play can cause abnormal signals to the nervous system (there are an abundance of nerve receptors in the joint). The muscles related to that joint can subsequently become tense or, conversely, underactive. The resulting muscle imbalance can place increased stress on the joint, aggravating the joint dysfunction that already exists.

Muscle Dysfunction

When joint dysfunction develops, muscles are affected. Some muscles respond by becoming tense and overactive, while others respond by becoming inhibited and underactive. In either case, these muscles can develop trigger points. Trigger points are areas of congestion within the muscle where sensitizing compounds accumulate. These sensitizing compounds can irritate the nerve endings within the muscle and produce pain. This pain can occur in the muscle itself or can be referred pain (perceived in other areas of the body). Muscle related mechanisms may also give rise to abnormal signaling to the nervous system. This event can subsequently cause disruption of the ability of the nervous system to properly regulate muscles in other parts of the body, leading to the development of faulty movement patterns.

Faulty Movement Patterns

It is thought that the intense barrage of pain signals from a traumatic injury to the cervical spine can change the way the nervous system controls the coordinated function of muscles. The disruption of coordinated, stable movement is known as faulty movement patterns. Faulty movement patterns cause increased strain in the muscles and joints, leading to pain. They can involve the neck itself or can arise from dysfunction in other areas of the body such as the foot or pelvis. Instability is also considered part of faulty movement patterns. There are 2 types of instability that can occur in whiplash: passive instability—the ligaments of the neck are loosened, and dynamic instability—the nervous system disruption causes a disturbance in the body's natural muscular response to common, everyday forces. As a result of instability, even mild, innocuous activities can become painful.

SUMMARY OF THE INVENTION

It has been found that the use of a TNF-alpha inhibitor, such as a substance selected from the group consisting of metalloproteinase inhibitors excluding methylprednisolone, tetracyclines including chemically modified tetracyclines, quinolones, corticosteroids, thalidomide, lazaroids, pentoxifylline, hydroxamic acid derivatives, carbocyclic acids, napthopyrans, soluble cytokine receptors, monoclonal antibodies towards TNF-alpha, amrinone, pimobendan, vesnarinone, phosphodiesterase inhibitors, lactoferrin and lactoferrin derived analogs, and melatonin are suitable for treatment of spinal disorders and nerve root injury caused by the liberation of TNF-alpha and compounds triggered by the liberation of or presence of TNF-alpha by inhibiting spinal disc TNF-alpha.

These substances are thus suitable for treatment of nerve root injury, and for treatment of sciatica, low back pain (LBP), and whiplash associated disorder (WAD). The substances can be used to treat nerve and spinal disorders such as nerve root injuries, a nerve disorder caused by or associated with a herniated disc(s), a nerve disorder involving pain, a nucleus pulposus-induced nerve injury, a spinal cord compression and sciatica.

TNF is one of many pro-inflammatory substances with similar action, and it is considered as a “major player” in inflammatory events. However, TNF may also in part acts through other pro-inflammatory cytokines such as for instance IL-1, IL-6, FAS, and IFN-gamma.

It is an object of the invention to provide novel and improved methods for inhibiting the action of TNF-alpha for treating disorders in a subject by administering a TNF-alpha inhibitor comprising the step of administering to said subject a therapeutically effective dosage of said TNF-alpha inhibitor, wherein said TNF-alpha inhibitor is a monoclonal antibody selected from CDP-571 (HUMICADE™) D2E7, and CDP-870.

It is an object of the invention to provide novel and improved methods for inhibiting the action of TNF-alpha for treating disorders in a subject by administering a TNF-alpha inhibitor comprising the step of administering to said subject a therapeutically effective dosage of a soluble cytokine receptor, such as etanercept.

Alternatively the TNF-alpha inhibitor used in the above method can be lactoferrin, CT3, ITF-2357, PD-168787, CLX-1100, M-PGA, NCS-700, PMS-601, RDP-58, TNF-484A, PCM-4, CBP-1011, SR-31747, AGT-1, Solimastat, CH-3697, NR58-3.14.3, RIP-3, Sch-23863 and SH-636.

The subject which can be treated by these methods include any vertebrate, preferably mammals, and of those, most preferably humans.

It is a more specific object of the invention to provide a novel pharmaceutical composition for treating nerve disorders in a subject comprising a therapeutically effective amount of a TNF-alpha inhibitor that is a monoclonal antibody selected from the group consisting of CDP-571 (HUMICADE™), D2E7, and CDP-870, and a pharmaceutically acceptable carrier, wherein said pharmaceutical composition inhibits nerve injury when administered to said subject. The pharmaceutical composition may comprise a therapeutically effective amount of a TNF-alpha inhibitor that is a soluble cytokine receptor, such as etanercept. The pharmaceutical composition alternatively can comprise one or more of these agents, or can comprise, alone or in combination, any of the agents discussed herein.

In another embodiment, the methods and pharmaceutical compositions described herein can be used to treat such nerve disorders as spinal disorders, nerve root injuries, a nerve disorder caused by or associated with a herniated disc(s), a nerve disorder involving pain, a nucleus pulposus-induced nerve injury, a spinal cord compression and sciatica.

Nerve disorders treatable with the method and the pharmaceutical composition according to the invention are, for example, nerve disorders due to a reduced nerve reduction velocity, spinal disorders, nerve root injuries, nerve disorders caused by disc herniation, sciatica, cervical rhizopathy, low back pain, whiplash associated disorder, nerve disorders involving pain, nucleus pulposus-induced nerve injuries, and spinal cord compressions.

The subject which can be treated by these methods include any vertebrate, preferably mammals, and of those, most preferably humans.

With the foregoing and other objects, advantages and features of the invention that will become hereinafter apparent, the nature of the invention may be more clearly understood by reference to the following detailed description of the preferred embodiments of the invention and to the appended claims.

DETAILED DESCRIPTION OF THE INVENTION

It has now surprisingly been shown possible to be able to treat nerve root injuries, or at least alleviate the symptoms of nerve root injuries by using a pharmaceutical composition comprising a therapeutically active amount of a TNF-alpha inhibitor. TNF-alpha inhibitors, include but are not limited to, metalloproteinase (MMP) inhibitors (excluding methylprednisolone), tetracyclines, chemically modified tetracyclines, quinolones, corticosteroids, thalidomide, lazaroids, pentoxifylline, hydroxamic acid derivatives, napthopyrans, soluble cytokine receptors, monoclonal antibodies towards TNF-alpha, amrinone, pimobendan, vesnarinone, phosphodiesterase inhibitors, lactoferrin and lactoferrin derived analogous, and melatonin in the form of bases or addition salts together with a pharmaceutically acceptable carrier.

By “therapeutically active amount” and “therapeutically effective dosage” are intended to be an amount that will lead to a desired therapeutic effect, i.e., an amount that will lead to an improvement of the patient's condition. In one preferred example, an amount sufficient to ameliorate or treat a condition associated with a nerve disorder. In some embodiments, the therapeutically effective amount is a dosage normally used when using such compounds for other therapeutic uses. Many of these drugs are commercially known registered drugs.

By “mammal” is meant to include but is not limited to primate, human, canine, porcine, equine, murine, feline, caprine, ovine, bovine, lupine, camelid, cervidae, rodent, avian and ichthyes. By animal is meant to include any vertebrate animal wherein there is a potential for nerve root injury.

As used herein, the term “antibody” is meant to refer to complete, intact antibodies, and Fab fragments, scFv, and F(ab)₂ fragments thereof. Complete, intact antibodies include monoclonal antibodies such as murine monoclonal antibodies (mAb), chimeric antibodies, humanized antibodies and human antibodies. The production of antibodies and the protein structures of complete, intact antibodies, Fab fragments, scFv fragments and F(ab)₂ fragments and the organization of the genetic sequences that encode such molecules, are well known and are described, for example, in Harlow et al., ANTIBODIES: A LABORATORY MANUAL, Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y. (1988) and Harlow et al., USING ANTIBODIES: A LABORATORY MANUAL, Cold Spring Harbor Press, 1999, which are herein incorporated by reference in their entirety.

By “epitope” is meant a region on an antigen molecule to which an antibody or an immunogenic fragment thereof binds specifically. The epitope can be a three dimensional epitope formed from residues on different regions of a protein antigen molecule, which, in a naive state, are closely apposed due to protein folding. “Epitope” as used herein can also mean an epitope created by a peptide or hapten portion of TNF-alpha and not a three dimensional epitope. Preferred epitopes are those wherein when bound to an immunogen (antibody, antibody fragment, or immunogenic fusion protein) results in inhibited or blocked TNF-alpha activity.

By “TNF-alpha blocking” is meant a compound or composition that blocks, inhibits or prevents the activity of TNF or TNF-alpha.

Compounds that possess TNF-alpha inhibitory activity are for example tetracyclines, (e.g., tetracycline, doxycycline, lymecycline, oxytetracycline, minocycline), and chemically modified tetracyclines (e.g., dedimethylamino-tetracycline), hydroxamic acid compounds, carbocyclic acids and derivatives, thalidomide, lazaroids, pentoxifylline, napthopyrans, soluble cytokine receptors, monoclonal antibodies towards INF-alpha, amrinone, pimobendan, vesnarinone, phosphodiesterase inhibitors, lactoferrin and lactoferrin derived analogs, melatonin, norfloxacine, ofloxacine, ciprofloxacine, gatifloxacine, pefloxacine, lomefloxacine, temafloxacine, TTP and p38 kinase inhibitors. These compounds can be present as bases or in the form of addition salts, whichever possesses the best or preferred pharmaceutical effect, and best property to be brought into a suitable pharmaceutical composition. A more complete list is given below.

Further, the active component can comprise a substance inhibiting a compound triggered by the release of TNF-alpha, such as interferon-gamma, interleukin-1, and nitrogen oxide (NO).

Aminoguanidine has been shown to inhibit the release of nitrogen oxide (NO) at nerve root injuries by inhibiting inducible nitrogen oxide synthetase, and aminoguanidine is thus one compound that inhibits a compound trigged by the release of TNF-alpha.

As stated above, there are several different types of cytokine blocking substances and pharmacological preparations that may be used according to the invention, and examples of those substances may be grouped in different subclasses: SPECIFIC TNF-A BLOCKING SUBSTANCES Monoclonal Antibodies infliximab, CDP-571, (HUMICADE ™), D2E7, CDP-870 Antibody Fragments CDP-870 Soluble Cytokine Receptors etanercept, lenercept, pegylated TNF- receptor type I, TBP-1 TNF-receptor antagonists Antisense oligonucleotides ISIS-104838 NON-SPECIFIC TNF-A BLOCKING SUBSTANCES MMP-inhibitors (or TACE-inhibitors, i.e. TNF Alpha Converting Enzyme-inhibitors), AG3340 (Prinomastat), Batimastat and Marimastat Tetracyclines Doxycycline, Lymecycline, Oxitetracycline, Tetracycline, Minocycline and synthetic tetracycline derivatives, such as CMT (i.e., Chemically Modified Tetracyclines such as KB-R7785; TIMP1 and 2, adTIMP2) Quinolones Norfloxacin, Levofloxacin, Enoxacin, Sparfloxacin, Temafloxacin, Moxifloxacin, Gatifloxacin, Gemifloxacin, Grepafloxacin, Trovafloxacin, Ofloxacin, Ciprofloxacin, Pefloxacin, Lomefloxacin and Temafloxacin Thalidomide derivatives Selective Cytokine inhibitors (SelCID), such as thalidomide derivatives such as CC-1088, CDC-501, and CDC-801 (ROQUININEX ®) Lazaroids non-glucocorticoid 21-aminosteroids such as U-74389G (16-desmethyl tirilazad) and U-74500 Prostaglandins Iloprost (prostacycline) Cyclosporins Pentoxifyllin derivatives Hydroxamic acid derivatives Napthopyrans Phosphodiesterase I, II, III, IV, and V- CC-1088, Ro 20-1724, rolipram, amrinone, inhibitors pimobendan, vesnarinone, SB 207499 (ARIFLO ®) Melanocortine agonists HP-228 Other TNF-a blocking agents Lactoferrin; CT3; ITF-2357; PD- 168787; CLX-1100; M-PGA; NCS- 700; PMS-601; RDP-58; TNF-484A; PCM-4; CBP-1011; SR-31747; AGT- 1; Solimastat; CH-3697; NR58-3.14.3; RIP-3; Sch-23863; Yissum project no. 11649; Pharma projects no. 6181, 6019 and 4657; SH-636 TNF Inhibitors Specific TNF Inhibitors

Monoclonal antibodies such as: infliximab, CDP-571 (HUMICADE™), D2E7 (Adalimumab), and the antibody fragment CDP-870; Polyclonal antibodies; Soluble cytokine receptors such as: etanercept, lenercept, pegylated TNF receptor type I, and TBP-1; TNF receptor antagonists; Antisense oligonucleotides such as: ISIS-104838

Non-Specific TNF Inhibitors

5,6-dimethylxanthenone-4-acetic acid (acemannan); AGT-1; ANA 245; AWD 12281; BN 58705; Caspase inhibitors; CBP-1011; CC 1069; CC 1080; CDC 801; CDDO; CH-3697; CLX 1100; CM 101; CT3; CT 2576; CPH 82; CV 1013; Cyclosporin; Compounds used in anti-cancer treatment such as: the binuclear DNA threading transition metal complexes and pharmaceutical compositions comprising them described in WO 99/15535, and methotrexate; Declopramide; DPC 333; DWP 205297; DY 9973; Edodekin alfa; Flt ligand (available from Immunex); Gallium nitrate; HP 228; Hydroxamic acid derivates; IL-12; IL-18; Ilodekacin; Ilomastat; ITF-2357; JTE 607; Lactoferrin; Lactoferrin derived or derivable peptides such as: the peptides described in WO 00/01730; Lazaroids; nonglucocorticoid 21-aminosteroids such as: U-74389G (16-desmethyl tirilazad), and U-74500; LPS agonist Esai; Melancortin agonists such as: HP-228; Mercaptoethylguanidine; Metoclopramide; MMP inhibitors (i.e. matrix metalloproteinase inhibitors or TACE inhibitors, i.e. TNF Alpha Converting Enzyme-inhibitors) such as: Tetracyclines such as: Doxycycline, Lymecycline, Oxitetracycline, Tetracycline, and Minocycline; Synthetic tetracycline derivates (CMT=Chemically Modified Tetracyclines); KB-R7785; TIMP1 and TIMP2; adTIMP2 and adTIMP2; M-PGA; Napthopyrans; NCS-700; Nimesulide; NR58-3.14.3; p38 kinase inhibitors such as: VX-702, VX-740, VX-745 (Pralnacasan), VX-765, VX-850, SB-202190, SB-203580, and Pyridinyl imidazoles; PCM-4; PD-168787; Pentoxifyllin derivates; Pharma projects no. 6181, 6019 and 4657; Phosphodiesterase I, II, III, IV, and V-inhibitors such as: CC-1088, Ro 20-1724, rolipram, amrinone, pimobendan, vesnarinone, and SB 207499; Piclamastat; PMS-601; Prostaglandins such as: Iloprost (prostacyclin); Quinolones (chinolones) such as: Norfloxacin, Levofloxacin, Enoxacin, Sparfloxacin, Temafloxacin, Moxifloxacin, Gatifloxacin, Gemifloxacin, Grepafloxacin, Trovafloxacin, Ofloxacin, Ciprofloxacin, Pefloxacin, Lomefloxacin, and Temafloxacin; RDP-58; RIP-3; Sch-23863; SH-636; Solimastat; SR-31747; Tasonermin; Thalidomide derivates (or SelCID=Selective Cytokin inhibitors, e.g. thalidomide derivate) such as: CC-1088 CDC-501, and CDC-801; TNF alpha proteinase inhibitor available from Immunex; TNF-484A; Tristetraproline (TTP) (available from AstraZeneca); VRCTC 310; Yissum project no. 11649; Zanamivir

Inhibitors of Interleukin-1 Alpha and Beta (IL-1α and IL-1β)

Specific Inhibitors of IL-1 Alpha and IL-1 Beta

Monoclonal antibodies such as: CDP-484; Soluble cytokine receptors; IL-1 type II receptor (decoy RII); Receptor antagonists such as: IL-1ra, anakinra (KINERET®), and ORTHOKIN®; Antisense oligonucleotides

Non-Specific Inhibitors of IL-1 Alpha and IL-1 Beta

MMP inhibitors (i.e. matrix metalloproteinase inhibitors) such as: Tetracyclines such as: Doxycycline, Trovafloxacin, Lymecycline, Oxitetracycline, Tetracycline, Minocycline, and synthetic tetracycline derivatives, such as CMT, i.e. Chemically Modified Tetracyclines; Prinomastat (AG3340); Batimastat; Marimastat; BB-3644; KB-R7785; TIMP-1, and TIMP-2, adTIMP-1 (adenoviral delivery of TIMP-1), and adTIMP-2 (adenoviral delivery of TIMP-2);

Quinolones (chinolones) such as: Norfloxacin, Levofloxacin, Enoxacin, Sparfloxacin, Temafloxacin, Moxifloxacin, Gatifloxacin, Gemifloxacin, Grepafloxacin, Trovafloxacin, Ofloxacin, Ciprofloxacin, Pefloxacin, Lomefloxacin, Temafloxacin; Prostaglandins; Iloprost (prostacyclin); Phosphodiesterase I, II, III, IV, and V-inhibitors; CC-1088, Ro 20-1724, rolipram, amrinone, pimobendan, vesnarinone, SB 207499

Inhibitors of Interleukin-6 (IL-6)

Specific Inhibitors of IL-6

Monoclonal antibodies; Soluble cytokine receptors; Receptor antagonists; Antisense oligonucleotides

Non-Specific Inhibitors of IL-6

MMP inhibitors (i.e. matrix metalloproteinase inhibitors) such as: Tetracyclines such as: Doxycycline, Lymecycline, Oxitetracycline, Tetracycline, Minocycline, and synthetic tetracycline derivatives, such as CMT, i.e. Chemically Modified Tetracyclines; Prinomastat (AG3340); Batimastat; Marimastat; BB-3644; KB-R7785; TIMP-1, and TIMP-2, adTIMP-1 (adenoviral delivery of TIMP-1), and adTIMP-2 (adenoviral delivery of TIMP-2);

Quinolones (chinolones) such as: Norfloxacin, Levofloxacin, Enoxacin, Sparfloxacin, Temafloxacin, Moxifloxacin, Gatifloxacin, Gemifloxacin, Grepafloxacin, Trovafloxacin, Ofloxacin, Ciprofloxacin, Pefloxacin, Lomefloxacin, Temafloxacin; Prostaglandins; Iloprost (prostacyclin); Cyclosporin Pentoxifyllin derivates; Hydroxamic acid derivates; Phosphodiesterase I, II, III, IV, and V-inhibitors; CC-1088, Ro 20-1724, rolipram, amrinone, pimobendan, vesnarinone, SB 207499; Melanin and melancortin agonists; HP-228

Inhibitors of Interleukin-8 (IL-8)

Specific Inhibitors of IL-8

Monoclonal antibodies; Soluble cytokine receptors; Receptor antagonists; Antisense oligonucleotides

Non-Specific Inhibitors of IL-8

Quinolones (chinolones) such as: Norfloxacin, Levofloxacin, Enoxacin, Sparfloxacin, Temafloxacin, Moxifloxacin, Gatifloxacin, Gemifloxacin, Grepafloxacin, Trovafloxacin, Ofloxacin, Ciprofloxacin, Pefloxacin, Lomefloxacin, Temafloxacin; Thalidomide derivates such as: SelCID, i.e. Selective Cytokine inhibitors such as: CC-1088, CDC-501, CDC-801 and Linomide (Roquininex®); Lazaroids; Cyclosporin; Pentoxifyllin derivates

FAS Inhibitors

Specific FAS Inhibitors

Monoclonal antibodies; Soluble cytokine receptors; Receptor antagonists; Antisense oligonucleotides

Non-Specific FAS Inhibitors

Inhibitors of FAS Ligands

Specific Inhibitors of FAS Ligands

Monoclonal antibodies; Soluble cytokine receptors; Receptor antagonists; Antisense oligonucleotides

Non-Specific Inhibitors of FAS Ligands

Inhibitors of Interferon-Gamma (IFN-Gamma)

Specific IFN-Gamma Inhibitors

Monoclonal antibodies; Soluble cytokine receptors; Receptor antagonists; Antisense oligonucleotides;

Non-Specific IFN-Gamma Inhibitors

MMP inhibitors (i.e. matrix metalloproteinase inhibitors) such as: Tetracyclines such as: Doxycycline, Trovafloxacin, Lymecycline, Oxitetracycline, Tetracycline, Minocycline, and synthetic tetracycline derivatives, such as CMT, i.e. Chemically Modified Tetracyclines; Prinomastat (AG3340); Batimastat; Marimastat; BB-3644; KB-R7785; TIMP-1, and TIMP-2, adTIMP-1 (adenoviral delivery of TIMP-1), and adTIMP-2 (adenoviral delivery of TIMP-2); Quinolones (chinolones) such as: Norfloxacin, Levofloxacin, Enoxacin, Sparfloxacin, Temafloxacin, Moxifloxacin, Gatifloxacin, Gemifloxacin, Grepafloxacin, Trovafloxacin, Ofloxacin, Ciprofloxacin, Pefloxacin, Lomefloxacin, Temafloxacin, Rebamipide, and Nalidixic acid; Lazaroids; Pentoxifyllin derivates; Phosphodiesterase I, II, III, IV, and V-inhibitors; CC-1088, Ro 20-1724, rolipram, amrinone, pimobendan, vesnarinone, SB 207499.

Also contemplated are the pharmaceutically acceptable bases and salts of the substances listed above.

Preferred groups of TNF-alpha blocking substances for use according to the present invention are soluble cytokine receptors, monoclonal antibodies, and tetracyclines or chemically modified tetracyclines.

Two preferred substances for use according to the present invention are the monoclonal antibodies, D2E7 and CDP-870.

D2E7 is a fully humanized monoclonal antibody directed against human TNF-alpha, which has been developed by Knoll and Cambridge Antibody Technology. A transgenic recombinant version of this antibody is under development by Genzyme Transgenic. The invention contemplates any antibody that binds to the same epitope as D2E7 or that has the same TNF-alpha inhibitory effect as D2E7. Preferably the antibody is primatized®, humanized or human.

CDP-870 (or CDP 870) is a humanized antibody fragment with high affinity to TNF-alpha. It has been developed by Celltech Group plc, and was co-developed with Pharmacia Corporation. The invention contemplates any antibody, antibody fragment or immunogen that binds to the same epitope as CDP-870 or that has the same TNF-alpha inhibitory activity as CDP-870. Preferably the antibody, antibody fragment or immunogen has the same or similar TNF-alpha inhibitory activity. Preferably the antibody, antibody fragment or immunogen is primatized, humanized or human.

Further, the active component may be a substance inhibiting a compound triggered by the release of TNF-alpha or part of a TNF-alpha cascade that is associated with nerve root injury, such as interferon-gamma (INF-γ), interleukin-1 (IL-1), and nitrogen oxide (NO).

It is possible to use either one or two or more substances according to the invention in the treatment, for example, of low back pain (LBP). When two or more substances are used they may be administered either simultaneously or separately.

Doxycycline inhibits the action of TNF in a non-specific manner. TNF and other similar bioactive substances are first produced in an inactive form and transported to the cell membrane. Upon activation, the active part of the pro-TNF is cleaved and released. This process is called shedding and may be initiated by one or more enzymes. These enzymes have in common that they are metalloproteinases, i.e. dependent of a metal-ion for their function. Doxycycline and other tetracyclines are known to bind to metal-ions and will thereby inhibit the action of metalloproteinases and subsequently the release of TNF and other pro-inflammatory cytokines in a non-specific manner. A monoclonal anti-TNF antibody, on the other hand, will bind directly to TNF and thereby inhibit TNF in a more specific way than doxycycline. The inhibition may thus be assumed to be more efficient but will be restricted to TNF. However, in the work leading to the present invention, it was found that anti-TNF treatment was more efficient than doxycycline treatment.

The substances according to the invention may also be administered in combination with other drugs or compounds, provided that these other drugs or compounds do not eliminate the desired effects according to the present invention, i.e., the effect on TNF-alpha.

The invention further relates to a method for inhibiting the symptoms of nerve root injury.

The effects of doxycycline, soluble cytokine-receptors, and monoclonal cytokine-antibodies have been studied and representative methods used and results obtained are disclosed below. Although the present invention has been described in detail with reference to examples herein, it is understood that various modifications can be made without departing from the spirit of the invention, and would be readily known to the skilled artisan.

The compounds of the invention can be administered in a variety of dosage forms, e.g., orally (per os), in the form of tablets, capsules, sugar or film coated tablets, liquid solutions; rectally, in the form of suppositories; parenterally, e.g., intramuscularly (i.m.), subcutaneous (s.c.), intracerebroventricular (i.c.v.), intrathecal (i.t.), epidurally, transepidermally or by intravenous (i.v.) injection or infusion; by inhalation; or intranasally.

The therapeutic regimen for the different clinical syndromes may be adapted to the disease or condition, medical history of the subject as would be know to the skilled artisan or clinician. Factors to be considered but not limiting to the route of administration, the form in which the compound is administered, the age, weight, sex, and condition of the subject involved.

For example, the oral route is employed, in general, for all conditions, requiring such compounds. In emergency cases, preference is sometimes given to intravenous injection. For these purposes, the compounds of the invention can be administered, for example, orally at doses ranging from about 20 to about 1500 mg/day. Of course, these dosage regimens may be adjusted to provide the optimal therapeutic response depending on the subject's condition.

The nature of the pharmaceutical composition containing the compounds of the invention in association with pharmaceutically acceptable carriers or diluents will, of course, depend upon the desired route of administration. The composition may be formulated in the conventional manner with the usual ingredients. For example, the compounds of the invention may be administered in the form of aqueous or oily solutions or suspensions, tablets, pills, gelatin capsules (hard or soft ones), syrups, drops or suppositories.

For oral administration, the pharmaceutical compositions containing the compounds of the invention are preferably tablets, pills or gelatine capsules, which contain the active substance or substances together with diluents, such as lactose, dextrose, sucrose, mannitol, sorbitol, cellulose; lubricants, e.g., silica, talc, stearic acid, magnesium or calcium stearate, and/or polyethylene glycols; or they may also contain binders, such as starches, gelatine, methyl cellulose, carboxymethylcellulose, gum arabic, tragacanth, polyvinylpyrrolidone; disaggregating agents such as starches, alginic acid, alginates, sodium starch glycolate, microcrystalline cellulose; effervescing agents, such a carbonates and acids; dyestuffs; sweeteners; wetting agents, such as lecithin, polysorbates, laurylsulphates; and in general non-toxic and pharmaceutically inert substances used in the formulation of pharmaceutical compositions. Said pharmaceutical compositions may be manufactured in known manners, e.g., by means of mixing, granulating, tableting, sugar-coating or film-coating processes. Film providing compounds can be selected to provide release in the right place or at the appropriate time in the intestinal tract with regard to absorption and maximum effect. Thus pH-dependent film formers can be used to allow absorption in the intestines as such, whereby different phthalates are normally used or acrylic acid/methacrylic acid derivatives and polymers.

The liquid dispersions for oral administration may be, e.g., syrups, emulsions, and suspensions.

The syrups may contain as carrier, e.g., saccharose, or saccharose with glycerine and/or mannitol and/or sorbitol.

Suspensions and emulsions may contain as Garner, e.g., a natural gum, such as gum arabic, xanthan gum, agar, sodium alginate, pectin, methyl cellulose, carboxymethylcellulose, polyvinyl alcohol.

The suspension or solutions for intramuscular injections may contain together with the active compound, a pharmaceutically acceptable carrier, such as e.g., sterile water, olive oil (or other vegetable or nut derived oil), ethyl oleate, glycols, e.g., propylene glycol, and if so desired, a suitable amount of lidocaine hydrochloride. Adjuvants for triggering the injection effect can be added as well.

The solutions for intravenous injection or infusion may contain as carrier, e.g., sterile water, or preferably, a sterile isotonic saline solution, as well as adjuvants used in the field of injection of active compounds. Such solutions would also be suitable for i.m. and i.c.v. injection.

The suppositories may contain together with the active compounds, a pharmaceutically acceptable carrier, e.g., cocoa-butter polyethylene glycol, a polyethylene sorbitan fatty acid ester surfactant or lecithin.

Examples of suitable doses of the active agents contemplated for different administration routes are given below. Per os 10-300 mg i.m. 25-100 mg i.v. 2.5-25 mg i.t. 0.1-25 mg (daily--every 3^(rd) month) inhalation 0.2-40 mg transepidermally 10-100 mg intranasally 0.1-10 mg s.c. 5-10 mg i.c.v. 0.1-25 mg (daily--every 3^(rd) month) epidurally 1-100 mg

These ranges are approximate (e.g., about 1 to about 100) and may vary depending on the specific agent being administered and the nature of the disorder in the subject. Thus, it is further contemplated that any dosage in between for the cited ranges may also be used.

Examples of suitable doses for different TNF-alpha inhibitors are given in the table below. More Most Preferred preferred preferred dosage dosage dosage TNF-alpha blocking substance and administration route Lenercept 5-200  10-100 30-80 i.v. (all given in mg for administration once every 4th week) TBP-1 5-200  10-100 30-80 i.v. (all given in mg for administration once every 4th week) CDP-571 (HUMICADE ®) 1-100  5-10  5-10 i.v. (all given in mg/kg body weight for administration as a single dose) D2E7 i.v. 0.1-50   0.5-10   1-10 s.c. 0.1-50   0.5-10   1-10 (all given in mg/kg body weight for administration as a single dose) Iloprost i.v. (all given in μg/kg body 0.1-2000    1-1500  100-1000 weight/day) intranasally (all given in μg/day) 50-250  100-150 100-150 Thalidomide 100-1200   300-1000 500-800 (all given in μg/day) CC-1088 50-1200 200-800 400-600 Per os (all given in mg/day) CDP-870 1-50   2-10 3-8 i.v. (all given in mg/kg body weight for administration once every 4th week) HP-228 5-100 10-50 20-40 i.v. (all given in μg/kg body weight) ISIS-10483 Per os 1-100 10-50 20-50 s.c. 1-100 10-50 20-50 i.v. (all given in mg) 1-100 10-50 20-50 ARIFLO ® (SB 207499 10-100  30-60 30-45 Per os (all given in mg/day) KB-R7785 100-500  100-300 150-250 s.c. (all given in mg/kg body weight/day) CDC-501 50-1200 200-800 400-600 Per os (all given in mg/day) CDC-801 (ROQUININEX ®) 50-1200 200-800 400-600 Per os (all given in mg/day) Prinomastat, Batimastat, and 1-250 mg  5-100 mg 10-50 mg Marimastat Per os (all given in mg twice/day) Linomide 0.1-25    5-20 10-15 Per os (all given in mg/kg body weight/day) IL-1 blocking substance and administration route Anakinra (KINERET ®) 10-200   50-150 100 s.c. (all given in mg/day)

Incorporation by Reference and Examples

Although the present invention has been described in detail with reference to examples below, it is understood that various modifications can be made without departing from the spirit of the invention, and would be readily known to the skilled artisan. All cited patents and publications referred to in this application are herein incorporated by reference in their entirety for all purposes.

The application incorporates herein by reference in their entirety International Application No. PCT/SE99/01670 and Swedish Application Nos. 9803276-6 and 9803710-4 for all purposes.

EXAMPLES Example 1 Study Design (Example 1)

The effects of nucleus pulposus and various treatments to block TNF-activity were evaluated in an experimental set-up using immunohistochemistry and nerve conduction velocity recordings.

Summary of Background Data (Example 1)

A meta-analysis of observed effects induced by nucleus pulposus reveals that these effects might relate to one specific cytokine, Tumor Necrosis Factor alpha (TNF-alpha).

Objectives (Example 1)

To assess the presence of TNF-alpha in pig nucleus pulposus cells and to see if blockage of TNF-alpha also blocks the nucleus pulposus-induced reduction of nerve root conduction velocity.

Methods (Example 1)

Series-1: Cultured nucleus pulposus-cells were immunohistologically stained with a monoclonal antibody for TNF-alpha.

Series-2: Nucleus pulposus was harvested from lumbar discs and applied to the sacrococcygeal cauda equina in 13 pigs autologously. Four pigs received 100 mg of doxycycline intravenously, 8 pigs had a blocking monoclonal antibody to TNF-alpha applied locally in the nucleus pulposus, and 4 pigs remained non-treated (controls). Three days after the application the nerve root conduction velocity was determined over the application zone by local electrical stimulation.

Series-3: Thirteen pigs had autologous nucleus pulposus placed onto their sacrococcygeal cauda equina similar to series-2. Five pigs (body weight 25 kg) received REMICADE® (infliximab) 100 mg i.v. preoperatively, and 8 pigs received ENBREL® (etanercept) 12.5 mg s.c. preoperatively and additionally 12.5 mg s.c. three days after the operation. Seven days after the nucleus pulposus-application the nerve root conduction velocity was determined over the application zone by local electrical stimulation according to series-2.

Results (Example 1)

Series-1: TNF-alpha was found to be present in the nucleus pulposus-cells.

Series-2: The selective antibody to TNF-alpha limited the reduction of nerve conduction velocity. However, treatment with doxycycline significantly blocked the nucleus pulposus-induced reduction of conduction velocity.

Series-3: Both drugs (infliximab, and etanercept) blocked the nucleus pulposus induced nerve injury efficiently. Normal average nerve conduction velocities were found after 15 treatment with both of these two drugs.

Conclusion (Example 1)

For the first time a specific substance, Tumor Necrosis Factor-alpha (TNF-alpha), has been linked to the nucleus pulposus-induced effects of nerve roots after local application. Although the effects of this substance may be synergistic with other similar substances, the data of the present study may be of significant importance for the continued understanding of nucleus pulposus' biologic activity, and might also be of potential use for future treatment strategies of sciatica and other nerve root injury conditions or related conditions.

After previously being considered as just a biologically inactive tissue component compressing the spinal nerve root at disc herniation, the nucleus pulposus has recently been found to be highly active, inducing both structural and functional changes in adjacent nerve roots when applied epidurally (28, 42, 43, 47, 49). It has thereby been established that autologous nucleus pulposus may induce axonal changes and a characteristic myelin injury (28, 43, 47, 49), increased vascular permeability (13), vascular coagulation (28, 41), and that membrane-bound structure or substances of the nucleus pulposus-cells are responsible for these effects (28, 42). The effects have also been found to be efficiently blocked by methylprednisolone and cyclosporin A (2, 43). When critically looking at these data, one realizes that there is at least one cytokine that relates to all of these effects, TNF-alpha.

To assess if TNF-alpha may be involved in the nucleus pulposus induced nerve root injury, the presence of TNF-alpha in nucleus pulposus-cells was assessed and was studied if the nucleus pulposus-induced effects could be blocked by doxycycline, a soluble TNF-receptor, and a selective monoclonal TNF-alpha antibody, the latter administered both locally in the nucleus pulposus and systemically.

Example 2 Material and Methods (Example 2)

Series-1, Presence of TNF-Alpha in Pig Nucleus Pulposus-Cells:

Nucleus pulposus (NP) from a total of 13 lumbar and thoracic discs were obtained from 10 pigs, which were used for other purposes. NP was washed once in Ham's F12 medium (Gibco BRL, Paisley, Scotland) and then centrifuged and suspended in 5 ml of collagenase solution in Ham's F12 medium (0.8 mg/ml, Sigma Chemical Co., St Louis, Mo., USA) for 40 minutes, at 37° C. in 25 cm tissue culture flasks. The separated NP-cell pellets were suspended in DMEM/F12 1:1 medium (Gibco BRL, Paisley, Scotland) supplemented with 1% L-glutamine 200 mM (Gibco BRL, Paisley, Scotland), 50 mg/ml gentamycine sulphate (Gibco BRL, Paisley, Scotland) and 10% fetal calf serum (FCS), (Gibco BRL, Paisley, Scotland). The cells were cultured at 37° C. and 5% CO₂ in air for 3-4 weeks and then cultured directly on tissue culture treated glass slides (Becton Dickinson & Co Labware, Franklin Lakes, N.J., USA). After 5 days on the glass slides, the cells were fixed in situ by exposing the slides to acetone for 10 minutes. After blocking irrelevant antigens by application of 3% H₂O₂ (Sigma Chemical Co., St Louis, Mo., USA) for 30 minutes and Horse Serum (ImmunoPure ABC, peroxidase mouse IgG staining kit nr.32028, Pierce, Rockford, Ill.) for 20 minutes, the primary antibody (Anti-pig TNF-alpha monoclonal purified antibody, Endogen, Cambridge, Mass., USA, Ordering Code MP-390) was applied over night at +40° C., diluted at 1:10, 1:20 and 1:40 dilutions. For control, BSA (bovine serum albumin, Intergen Co, New York, USA) suspended in PBS (phosphate buffered saline, Merck, Darmstadt, Germany) was applied in the same fashion. The next day the cells were washed with 1% BSA in PBS and the secondary antibody (ImmunoPure ABC, peroxidase mouse IgG staining kit Cat. Cat. #32028, Pierce, Rockford, Ill.) was applied for 30 minutes. To enhance this reaction, the cells were exposed to Avidin-Biotin complex for an additional 30 minutes (ImmunoPure ABC, peroxidase mouse IgG staining kit Cat. #32028, Pierce, Rockford, Ill.). The cells were then exposed to 20 mg of DAB (3,3-diaminobenzidine tetrahydrochloride No. D-5905, Sigma Chemical Co., St Louis, Mo., USA) and 0.033 ml of 3% H₂O₂ in 10 ml of saline for 10 minutes. The cells were washed in PBS, dehydrated in a series of ethanol, mounted and examined by light microscopy by an unbiased observer for the presence of a brown coloration indicating the presence of TNF-alpha.

Series-2 Neurophysiologic Evaluation:

Thirteen pigs (body weight 25-30 kg) received an intramuscular injection of 20 mg/kg body weight of KETALAR® (ketamine, 50 mg/ml, Parke-Davis, Morris Plains, N.J.) and an intravenous injection of 4 mg/kg body weight of HYPNODIL® (methomidate chloride, 50 mg/ml, AB Leo, Helsingborg, Sweden) and 0.1 mg/kg body weight of STRESNIL® (azaperon, 2 mg/ml, Janssen Pharmaceutica, Beerse, Belgium). Anesthesia was maintained by additional intravenous injections of 2 mg/kg body weight of HYPNODIL® and 0.05 mg/kg body weight of STRESNIL®. The pigs also received an intravenous injection of 0.1 mg/kg of STESOLID NOVUM® (Diazepam, Dumex, Helsingborg, Sweden) after surgery.

Nucleus pulposus was harvested from the 5.sup.th lumbar disc through a retro peritoneal approach (49). Approximately 40 mg of the nucleus pulposus was applied to the sacrococcygeal cauda equina through a midline incision and laminectomy of the first coccygeal vertebra. Four pigs did not receive any treatment (no treatment). Four other pigs received an intravenous infusion of 100 mg of doxycycline (Vibramycino, Pfizer Inc., New York, USA) in 100 ml of saline over 1 hour. In 5 pigs, the nucleus pulposus was mixed with 100 μl of a 1.11 mg/mL suspension of the anti-TNF-alpha antibody used in series 1, before application.

Three days after the application, the pigs were re-anesthetized by an intramuscular injection of 20 mg/kg body weight of KETALAR® and an intravenous injection of 35 mg/kg body weight 25 of PENTOTHAL® (Thiopental sodium, Abbott lab, Chicago, Ill.).

The pigs were ventilated on a respirator. Anesthesia was maintained by an intravenous bolus injection of 100 mg/kg body weight of Chloralose ((a)-D(+)-gluco-chloralose, Merck, Darmstadt, Germany) and by a continuous supply of 30 mg/kg/hour of Chloralose. A laminectomy from the 4^(th) sacral to the 3^(rd) coccygeal vertebra was performed. The nerve roots were covered with SPONGOSTANE® (Ferrosan, Denmark). Local tissue temperature was continuously monitored and maintained at 37.5-38.0° C. by means of a heating lamp.

The cauda equina was stimulated by two E2 subdermal platinum needle electrodes (Grass Instrument Co., Quincy, Mass.) which were connected to a Grass SD9 stimulator (Grass Instrument Co., Quincy, Mass.) and gently placed intermittently on the cauda equina first 10 mm cranial and then 10 mm caudal to the exposed area. To ensure that only impulses from exposed nerve fibers were registered, the nerve root that exited from the spinal canal between the two stimulation sites were cut. An electromyogram (EMG) was registered by two subdermal platinum needle electrodes which were placed into the paraspinal muscles in the tail approximately 10 mm apart. This procedure is reproducible and represents a functional measurement of the motor nerve fibers of the cauda equina nerve roots. The EMG was visualized using a Macintosh IIci computer provided with Superscope software and MacAdios II AID converter (GW Instruments, Sommerville, Mass.) together with a Grass P18 preamplifier (Grass Instrument Co., Quincy, Mass.). The separation distance between the first peaks of the EMG from the two recordings was determined, and the separation distance between the two stimulation sites on the cauda equina was measured with calipers. The nerve conduction velocity between the two stimulation sites could thus be calculated from these two measurements.

The person performing the neurophysiologic analyses was unaware of the experimental protocol for the individual animal. After finishing the complete study, the data were arranged in the three experimental groups and statistical differences between the groups were assessed by Student's t-test. The experimental protocol for this experiment was approved by the local animal research ethics committee.

Series-3:

Thirteen pigs had autologous nucleus pulposus placed onto their sacrococcygeal cauda equina similar to series-2. Five pigs (bodyweight 25 kg) received the human/murine monoclonal antibody, REMICADE® (infliximab, Immunex Corporation, Seattle, Wash. 98101, USA) 100 mg i.v. preoperatively, and 8 pigs received ENBREL® (etanercept, Centocor B.V., Leiden, the Netherlands) 12.5 mg s.c. preoperatively and additionally 12.5 mg s.c. three days after the operation. Seven days after the nucleus pulposus-application the nerve root conduction velocity was determined over the application zone by local electrical stimulation according to series-2. To blind the study, the neurophysiological evaluation was conducted in parallel to another study and the person performing the analyses did not know from which study and what treatment each specific animal was subjected to. No non-treated animals were included in the series-3 due to the pre-existing knowledge of nerve conduction velocity after seven days of either nucleus pulposus or fat (control) application. The statistical difference between the groups, infliximab, and etanercept, nucleus pulposus without treatment (positive control from previous data) and application of retroperitoneal fat (negative control from previous data) was assessed by using ANOVA and Fisher's PLSD at 5%.

Results (Example 2)

Series-1, Presence of TNF-Alpha in Pig Nucleus Pulposus-Cells:

Examples of the light microscopic appearance of the stained glass slides. In the sections using BSA in PBS as “primary antibody” (control), no staining was observed, ensuring that there was no labeling and visualization of irrelevant antigens. When the anti-TNF-alpha antibody was applied at 1:40 dilution there was only weak staining. However, the staining increased with diminishing dilutions of the antibody. The staining was seen in the soma of the cells, and it was not possible to differentiate whether TNF-alpha was located in the cytoplasm, on the cell surface bound to the cell-membrane, or both.

Series-2 Neurophysiologic Evaluation:

Application of non-modified nucleus pulposus and without any treatment induced a reduction in nerve conduction velocity similar to previous studies (Table 1). In contrast, treatment with doxycycline completely blocked this reduction (p<0.01 Student's t-test). Local application of anti-TNF-alpha-antibody also induced a partial block of this reduction, although not as complete as doxycycline and was not statistically significant as compared to the no treatment-series.

Series-3:

Treatment with both drugs seemed to prevent the nucleus pulposus-induced reduction of nerve root conduction velocities, since the average nerve conduction velocity for both these treatment groups were close to the average conduction of the fat-application series, as seen in a previous study (Table 2). The average nerve conduction velocity in pigs treated with ENBREL® was statistically different from the average nerve conduction velocity in the series with pigs with no treatment. The average new conduction velocity in the group treated with REMICADE® was also statistically significantly different from the average nerve conduction velocity in the group with no treatment. TABLE 1 Series 2 Treatment n NCV (m/s +/− SD) Local anti-TNF alpha 5 64 +/− 28 Doxycycline 4 76 +/− 9  No treatment 4 46 +/− 12

TABLE 2 Series 3 Treatment n NCV (m/s +/− SD) Fat* 5 76 +/− 11 ENBREL ® 8 78 +/− 14 REMICADE ® 5 79 +/− 15 No treatment* 5 45 +/− 19 *Data included from reference 49. Discussion (Example 2)

The data of the present study demonstrated that TNF-alpha may be found in nucleus pulposus-cells of the pig. If TNF-alpha was blocked by a locally applied selective monoclonal antibody, the nucleus pulposus-induced reduction of nerve root conduction velocity was partially blocked, although not statistically significant as compared to the series with non-treated animals. However, if animals were treated systemically with doxycycline, infliximab, and etanercept to inhibit TNF-alpha, the reduction of nerve conduction velocity was significantly prevented.

In recent years, it has been verified that local application of autologous nucleus pulposus may injure the adjacent nerve roots. Thus, it has become evident that the nerve root injury seen as disc herniation may not be solely based on mechanical deformation of the nerve root, but may also be induced by unknown “biochemical effects” related to the epidural presence of herniated nucleus pulposus. Although this new research field has generated many experimental studies, the mechanisms and substances involved are not fully known. It has been seen that local application of autologous nucleus pulposus may induce axonal injury (28, 42, 43, 46, 47, 49), a characteristic injury of the myelin sheath (28, 43, 46, 47, 49), a local increase of vascular permeability (13, 41) infra vascular coagulations, reduction of infra neural blood flow (50), and leukotaxis (41). It has been seen that the nucleus pulposus-related effects may be blocked efficiently by methylprednisolone (43) and cyclosporin A (2), and slightly less efficiently by indomethacin (3), and lidocaine (77). Further, it has been understood that the effects are mediated by the nucleus pulposus-cells (42), particularly by substances or structures bound to the cell-membranes (29). When critically considering these data, it becomes evident that at least one specific cytokine could be related to these observed effects, Tumor Necrosis Factor-alpha (TNF-alpha). TNF-alpha may induce nerve injury (34, 36, 52, 57, 73), mainly seen as a characteristic myelin injury that closely resembles the nucleus pulposus-induced myelin-injury (34, 54, 58, 61, 69, 71, 73, 78). TNF-alpha may also induce an increase in vascular permeability (54, 73) and initiate coagulation (22, 39, 70). Further, TNF-alpha may be blocked by steroids (4, 11, 26, 68, 76), and cyclosporin A (15, 62, 74, 76). However, the blocking effect on TNF-alpha is not so pronounced by NSAID (18, 21, 24) and very low or the agonized by lidocaine (5, 37, 53, 67).

It was recently observed that local application of nucleus pulposus may induce pain-related behavior in rats, particularly thermal hyperalgesia (27, 46). TNF-alpha has also been found to be related to such pain-behavioristic changes (16, 40, 63, 73), and also to neuropathies in general (35, 61, 63, 64). However there are no studies that have assessed the possible presence of TNF-alpha in the cells of the nucleus pulposus.

To assess if TNF-alpha could be related to the observed nucleus pulposus induced reduction in nerve root conduction velocity it was necessary first to analyze if there was TNF-alpha in the nucleus pulposus-cells. The data clearly demonstrated that TNF-alpha was present in these cells. TNF-alpha is produced as a precursor (pro-TNF) that is bound to the membrane, and it is activated by cleavage from the cell-membrane by a zinc-dependent metallo-endopeptidase (i.e., TNF-alpha converting enzyme, TACE) (6, 19, 20, 55, 56). This may thus relate well to experimental findings, where application of only the cell-membranes of autologous nucleus pulposus-cells induced nerve conduction velocity reduction, which indicated that the effects were mediated by a membrane-bound substance. Second, the effects of the TNF-alpha had to be blocked in a controlled manner. We then first chose to add the same selective antibody that was used for immunohistochemistry in series 1, which is known to also block the effects of TNF-alpha, to the nucleus pulposus before application. Also, we chose to treat the pigs with doxycycline, which is known to block TNF-alpha (30, 31, 38, 59, 60). However, due to the low pH of the doxycycline preparation, it was chosen to treat the pigs by intravenous injection instead of local addition to the nucleus pulposus since nucleus pulposus at a low pH has been found to potentiate the effects of the nucleus pulposus (43, 25).

Two recently developed drugs for specific TNF-alpha inhibition were also included in the study. Infliximab is a chimeric monoclonal antibody composed of human constant and murine variable regions. Infliximab binds specifically to human TNF-alpha. As opposed to the monoclonal antibody used in series-2 for the 3-day observation period, infliximab was not administered locally in the autotransplanted nucleus pulposus, but instead was administered systemically in a clinically recommended dose (4 mg/kg).

Etanercept is a dimeric fusion protein consisting of the Fc portion of human IgG. The drug, etanercept, was administered in a dosage comparable to the recommended dose for pediatric use (0.5 mg/kg, twice a week).

The data regarding nerve conduction velocity showed that the reduction was completely blocked by the systemic-treatment and that the nerve conduction velocities in these series were close to the conduction velocity after application of a control substance (retro peritoneal fat) from a previous study (49). Application of the anti-TNF-alpha-antibody to the nucleus pulposus also partially prevented the reduction in nerve conduction velocity. However, the reduction was not as pronounced as that observed for doxycycline, and the velocity in this series was not statistically different to the velocity in the series with untreated animals, given the wide deviation of the data.

The local anti-TNF-alpha antibody treatment only partially blocked the nucleus pulposus-induced reduction of nerve conduction velocity and the high standard deviation of the data could probably have at least three different explanations. First, if looking at the specific data within this group, it was found that the nerve conduction velocity was low in 2 animals (mean 37.5 m/s) and high in 3 animals (mean 81.3 m/s). There are thus 2 groups of distinctly different data within the anti-TNF-alpha treatment series. This will account for the high standard deviation and might imply that the blocking effect was sufficient in 3 animals and insufficient in 2 animals. The lack of effects in these animals could be based simply on the amount of antibodies in relation to TNF-alpha molecules not being sufficient, and if a higher dose of the antibody had been used, the TNF-alpha effects would thus have been blocked even in these animals. Such a scenario could then theoretically imply that TNF-alpha alone is responsible for the observed nucleus pulposus-induced effects, and that this could not be verified experimentally due to the amount of antibody being too low.

Second, it is also known that tetracyclines such as doxycycline and minocycline may block a number of cytokines and other substances. For instance they may block IL-1 (1, 33, 65), IFN-gamma, NO-synthetase, and metalloproteinases (1, 60, 65). Particularly IL-1 and IFN-gamma are known to act synergistically with TNF-alpha and are known to be more or less neurotoxic (7, 14, 17, 22, 23, 63, 66). These substances, are also blocked by steroids and cyclosporin A which corresponds well with the previous observations on nucleus pulposus-induced nerve root injury which have shown that the nucleus pulposus-induced effects may be blocked by these substances (11, 74). One may therefore also consider the possibility that a selective block of TNF-alpha may not be sufficient to completely block the nucleus pulposus-induced effects on nerve function, and that simultaneous block of other synergistic substances is necessary as well. Thus, this scenario, on the other hand, implies that TNF-alpha is not solely responsible for the nucleus pulposus-induced effects, and that other synergistic substances, which are also blocked by doxycycline, may be necessary.

The third explanation could be that the amount of TNF in the nucleus pulposus may well be enough to start the pathophysiologic cascade locally in the nerve root, comprising increased vascular permeability and aggregation and recruitment of systemic leukocytes. However, it is these leukocytes that have the major content of TNF-alpha and that systemic treatment in a sufficient dose is necessary to block the contribution from these leukocytes, and thereby also blocking the events leading to nerve injury.

TNF-alpha may have various pathophysiologic effects. It may have direct effects on tissues such as nerve tissue and blood vessels, it may trigger other cells to produce other pathogenic substances and it may trigger release of more TNF-alpha both by inflammatory cells and also by Schwann-cells locally in the nerve tissue (72). There is thus reason to believe that even low amounts of TNF-alpha may be sufficient to initiate these processes and that there is a local recruitment of cytokine producing cells and a subsequent increase in production and release of other cytokines as well as TNF-alpha. TNF-alpha may therefore act as the “ignition key” of the pathophysiologic processes and play an important role for the initiation of the pathophysiologic cascade behind the nucleus pulposus-induced nerve injury. However, the major contribution of TNF-alpha may be derived from recruited, aggregated and maybe even extravasated leukocytes, and that successful pharmacologic block may be achieved only by systemic treatment.

In conclusion, although the exact role of TNF-alpha can not be fully understood from the experimental set-up, we may conclude that for the first time a specific substance (TNF-alpha) has been linked to the nucleus pulposus-induced nerve root injury. This new information may be of significant importance for the continued understanding of nucleus pulposus-induced nerve injury as well as raising the question of the potential future clinical use of pharmacological interference with TNF-alpha and related substances, for treatment of sciatica.

The presence of TNF-alpha in pig nucleus pulposus-cells was thus immunohistochemically verified. Block of TNF-alpha by a locally applied monoclonal antibody limited the nucleus pulposus-induced reduction of nerve root conduction velocity, whereas intravenous treatment with doxycycline, infliximab, and etanercept significantly blocked this reduction. These data for the first time links one specific substance, TNF-alpha, to the nucleus pulposus-induced nerve injury.

Example 3 CDP-571 (HUMICADE®)

A 43-year old man with radiating pain corresponding to the left 4th lumbar nerve root is diagnosed as having sciatica with nerve root disturbance. He will be treated with 10 mg/kg of CDP-571 (HUMICADE®) intravenously in a single dose.

Example 4 D2E7

A 38-year old female with radiating pain and slight nerve dysfunction corresponding to the 1st sacral nerve on the left side is diagnosed as having a disc herniation with sciatica. She will be treated with an intravenous injection of 5 mg/kg of D2E7.

Example 5 CDP-870

A 41-year old female with dermatomal pain corresponding to the first sacral nerve root on the left side is examined revealing no neurological deficit but a positive straight leg raising test on the left side. She will be treated with an intravenous injection of 5 mg/kg of CDP-870.

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1. A method of treating a spinal disorder in a human by use of a TNF-alpha inhibitor, the method comprising: a) administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor selected from the group consisting of etanercept, soluble TNF receptor Type I, pegylated soluble TNF receptor Type I, and TBP-1; and b) administering the therapeutically effective dosage parenterally, either systemically or locally.
 2. A method of treating a nerve disorder involving pain in a human by use of a TNF-alpha inhibitor, the method comprising: a) administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor selected from the group consisting of etanercept, soluble TNF receptor Type I, pegylated soluble TNF receptor Type I, and TBP-1; and b) administering the therapeutically effective dosage parenterally, either systemically or locally.
 3. A method of treating low back pain in a human by use of a TNF-alpha inhibitor, the method comprising: a) administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor selected from the group consisting of etanercept, soluble TNF receptor Type I, pegylated soluble TNF receptor Type I, and TBP-1; and b) administering the therapeutically effective dosage parenterally, either systemically or locally.
 4. The method of claim 3, wherein the TNF-alpha inhibitor is administered subcutaneously, intramuscularly, or epidurally.
 5. A method of treating low back pain in a human by use of a TNF-alpha inhibitor, the method comprising: a) administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor selected from the group consisting of etanercept and TBP-1; and b) administering the therapeutically effective dosage parenterally, either systemically or locally.
 6. A method for treating a spinal disorder in a human by use of a TNF-alpha inhibitor, the method comprising: a) administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor selected from the group consisting of etanercept and TBP-1; and b) administering the therapeutically effective dosage parenterally, either systemically or locally.
 7. A method for treating a nerve root disorder involving TNF-alpha-mediated inflammation in a human by inhibiting TNF-alpha, the method comprising: a) administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor selected from the group consisting of etanercept and TBP-1; and b) administering the therapeutically effective dosage parenterally, either systemically or locally.
 8. A method for treating a nerve root disorder involving TNF-alpha-mediated inflammation in a human by inhibiting TNF-alpha, the method comprising: a) administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor selected from the group consisting of etanercept, infliximab, CDP 870, D2E7, soluble TNF receptor Type I, pegylated soluble TNF receptor Type I, and TBP-1; and b) administering the therapeutically effective dosage parenterally, either systemically or locally.
 9. A method of treating low back pain in a human by use of a TNF-alpha inhibitor, the method comprising: a) administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor selected from the group consisting of soluble TNF receptor Type I and pegylated soluble TNF receptor Type I; and b) administering the therapeutically effective dosage parenterally, either systemically or locally.
 10. A method of treating a nerve disorder involving pain in a human by use of a TNF-alpha inhibitor, the method comprising: a) administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor selected from the group consisting of etanercept and TBP-1; and b) administering the therapeutically effective dosage parenterally, either systemically or locally.
 11. A method for inhibiting the action of TNF-alpha for treating nerve disorders in a human by administering a TNF-alpha inhibitor, the method comprising administering to the human a therapeutically effective dosage of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is CDP-571, D2E7, or CDP-870, and the TNF-alpha inhibitor is administered parenterally, either systemically or locally.
 12. The method of claim 11, wherein the TNF-alpha inhibitor is administered subcutaneously or intramuscularly.
 13. The method of claim 11, wherein the nerve disorder is nucleus pulposus-induced nerve injury.
 14. The method of claim 11, wherein the nerve disorder is caused by herniated discs.
 15. The method of claim 11, wherein the nerve disorder is spinal cord compression.
 16. The method of claim 11, wherein the TNF-alpha inhibitor is CDP-870 and is administered subcutaneously in a dose of about 1 mg/kg to about 50 mg/kg body weight of the human.
 17. The method of claim 11, wherein the TNF-alpha inhibitor is D2E7 and is administered subcutaneously in a dose of about 0.1 mg/kg to about 50 mg/kg body weight of the human.
 18. A method for inhibiting the action of TNF-alpha for treating nerve disorders in a human, the method comprising the step of: (A) administering parenterally, either systemically or locally, a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is selected from the group consisting of (i) a soluble cytokine receptor that blocks TNF-alpha and (ii) a monoclonal antibody that blocks TNF-alpha.
 19. The method of claim 18, wherein the TNF-alpha inhibitor is administered subcutaneously or intramuscularly.
 20. The method of claim 18, wherein the nerve disorder is nucleus pulposus-induced nerve injury.
 21. The method of claim 18, wherein the nerve disorder is caused by herniated discs.
 22. The method of claim 18, wherein the nerve disorder is spinal cord compression.
 23. The method of claim 18, wherein the TNF-alpha inhibitor is a soluble cytokine receptor that blocks TNF-alpha and is administered intramuscularly.
 24. The method of claim 18, wherein the TNF-alpha inhibitor is a soluble cytokine receptor that blocks TNF-alpha and is administered subcutaneously.
 25. A method for inhibiting the action of TNF-alpha for treating neurological conditions in a human by administering a TNF-alpha inhibitor for reducing inflammation of nerve tissue of the human or for reducing the injury to nerve tissue, the method comprising the step of: (A) administering a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is selected from the group consisting of etanercept and infliximab for reducing inflammation of nerve tissue of the human or reducing the injury to nerve tissue.
 26. A method for inhibiting the action of TNF-alpha for treating a spinal disorder involving pain in a human, the method comprising the step of: (A) administering parenterally, either systemically or locally, a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is selected from the group consisting of (i) a soluble cytokine receptor that blocks TNF-alpha and (ii) a monoclonal antibody that blocks TNF-alpha.
 27. A method for inhibiting the action of TNF-alpha for treating nerve root injury in a human by administering a TNF-alpha inhibitor, the method comprising administering to the human a therapeutically effective dosage of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is CDP-571, D2E7, or CDP-870, and the TNF-alpha inhibitor is administered parenterally, either systemically or locally.
 28. A method for inhibiting the action of TNF-alpha for treating nerve root injury in a human, the method comprising the step of: (A) administering parenterally, either systemically or locally, a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is selected from the group consisting of (i) a soluble cytokine receptor that blocks TNF-alpha and (ii) a monoclonal antibody that blocks TNF-alpha, which when administered to the human treats the nerve root injury.
 29. A method for inhibiting the action of TNF-alpha for treating nerve disorders in a human by administering a TNF-alpha inhibitor, the method comprising administering to the human a therapeutically effective dosage of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is CDP-571, D2E7, or CDP-870.
 30. A method for inhibiting the action of TNF-alpha for treating nerve disorders in a human, the method comprising the step of: (A) administering a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is selected from the group consisting of (i) a soluble cytokine receptor that blocks TNF-alpha and (ii) a monoclonal antibody that blocks TNF-alpha.
 31. The method of claim 30, wherein the TNF-alpha inhibitor is administered subcutaneously or intramuscularly.
 32. The method of claim 30, wherein the TNF-alpha inhibitor is a soluble cytokine receptor that blocks TNF-alpha and is administered subcutaneously.
 33. The method of claim 30, wherein the TNF-alpha inhibitor is a monoclonal antibody that blocks TNF-alpha and is administered subcutaneously.
 34. The method of claim 30, wherein the TNF-alpha inhibitor is a soluble cytokine receptor that blocks TNF-alpha and is administered intramuscularly.
 35. The method of claim 30, wherein the TNF-alpha inhibitor is a monoclonal antibody that blocks TNF-alpha and is administered intravenously.
 36. The method of claim 30, wherein the TNF-alpha inhibitor is a soluble cytokine receptor that blocks TNF-alpha and is administered parenterally, either systemically or locally.
 37. The method of claim 30, wherein the TNF-alpha inhibitor is a monoclonal antibody that blocks TNF-alpha and is administered parenterally, either systemically or locally.
 38. The method of claim 30, wherein the TNF-alpha inhibitor is administered intravenously.
 39. The method of claim 30, wherein the TNF inhibitor is a soluble cytokine receptor that blocks TNF-alpha and is administered intravenously.
 40. The method of claim 30, wherein the TNF-alpha inhibitor is administered intramuscularly, intravenously, subcutaneously, or orally.
 41. The method of claim 30, wherein the TNF-alpha inhibitor is administered parenterally, either systemically or locally.
 42. The method of claim 30, wherein the TNF-alpha inhibitor is administered intramuscularly, intravenously, or subcutaneously.
 43. The method of claim 30, wherein the nerve disorder is a spinal disorder, a nerve root injury, a nerve disorder caused by herniated discs, sciatica, a nerve disorder that involves pain, a nucleus pulposus-induced nerve disorder, or spinal cord compression.
 44. The method of claim 30, wherein the nerve disorder is caused by herniated discs.
 45. The method of claim 30, wherein the nerve disorder is spinal cord compression.
 46. The method of claim 30, wherein the nerve disorder is nerve root injury.
 47. The method of claim 30, wherein the nerve disorder is a spinal disorder.
 48. The method of claim 30, wherein the nerve disorder involves pain.
 49. A method for inhibiting the action of TNF-alpha for treating nerve root injury in a human, the method comprising the step of: (A) locally administering by subcutaneous administration a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is a soluble cytokine receptor that blocks TNF-alpha, which when administered to the human treats the nerve root injury.
 50. The method of claim 49, wherein the nerve root injury is a nucleus pulposus-induced nerve injury.
 51. The method of claim 49, wherein the nerve root injury is caused by herniated discs.
 52. A method for inhibiting the action of TNF-alpha for treating a nerve disorder caused by herniated discs in a human by administering a TNF-alpha inhibitor, the method comprising administering to the human a therapeutically effective dosage of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is CDP-571, D2E7, or CDP-870, and the TNF-alpha inhibitor is administered parenterally, either systemically or locally.
 53. A method for inhibiting the action of TNF-alpha for treating a nucleus pulposus-induced nerve disorder in a human by administering a TNF-alpha inhibitor, the method comprising administering to the human a therapeutically effective dosage of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is CDP-571, D2E7, or CDP-870, and the TNF-alpha inhibitor is administered parenterally, either systemically or locally.
 54. A method for inhibiting the action of TNF-alpha for treating a nerve disorder caused by herniated discs in a human, the method comprising the step of: (A) administering parenterally, either systemically or locally, a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is selected from the group consisting of (i) a soluble cytokine receptor that blocks TNF-alpha and (ii) a monoclonal antibody that blocks TNF-alpha.
 55. A method for inhibiting the action of TNF-alpha for treating a nucleus pulposus-induced nerve disorder in a human, the method comprising the step of: (A) administering parenterally, either systemically or locally, a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is selected from the group consisting of (i) a soluble cytokine receptor that blocks TNF-alpha and (ii) a monoclonal antibody that blocks TNF-alpha.
 56. A method for inhibiting the action of TNF-alpha for treating spinal cord compression in a human, the method comprising the step of: (A) administering parenterally, either systemically or locally, a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is selected from the group consisting of (i) a soluble cytokine receptor that blocks TNF-alpha and (ii) a monoclonal antibody that blocks TNF-alpha.
 57. A method for inhibiting the action of TNF-alpha for treating nerve disorders in a human by administering a TNF-alpha inhibitor comprising the step of: (A) administering parenterally, either systemically or locally, a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is a monoclonal antibody that blocks TNF-alpha.
 58. A method for inhibiting the action of TNF-alpha for treating a spinal disorder in a human by administering a TNF-alpha inhibitor, the method comprising administering to the human a therapeutically effective dosage of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is CDP-571, D2E7, or CDP-870, and the TNF-alpha inhibitor is administered parenterally, either systemically or locally.
 59. A method for inhibiting the action of TNF-alpha for treating a nerve disorder involving pain in a human, the method comprising the step of: (A) administering parenterally, either systemically or locally, a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is selected from the group consisting of (i) a soluble cytokine receptor that blocks TNF-alpha and (ii) a monoclonal antibody that blocks TNF-alpha.
 60. The method of claim 59, wherein the TNF-alpha inhibitor is a soluble cytokine receptor that blocks TNF-alpha and is administered intramuscularly.
 61. The method of claim 59, wherein the TNF-alpha inhibitor is a soluble cytokine receptor that blocks TNF-alpha and is administered subcutaneously.
 62. The method of claim 59, wherein the TNF-alpha inhibitor is a soluble cytokine receptor that blocks TNF-alpha and is administered subcutaneously.
 63. A method for inhibiting the action of TNF-alpha for treating nerve root injury in a human, the method comprising the step of: (A) administering parenterally, either systemically or locally, a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is a soluble cytokine receptor that blocks TNF-alpha, which when administered to the human treats the nerve root injury.
 64. A method for the treatment of spinal disorders such as nerve root injury caused by the liberation of TNF-alpha in mammals, including man, comprising the administration of a pharmaceutically effective amount of etanercept.
 65. The method of claim 64, wherein the nerve root injury is a nucleus pulposus-induced nerve injury.
 66. The method of claim 64, wherein the nerve root injury is induced by disc herniation.
 67. A method for the treatment of spinal disorders such as nerve root injury caused by the liberation of TNF-alpha in mammals, including man, comprising the administration of a pharmaceutically effective amount of infliximab.
 68. A method for the treatment of spinal disorders such as nerve root injury caused by the liberation of TNF-alpha and compounds triggered by the liberation of or presence of TNF-alpha in mammals, including man, the method comprising the administration of a pharmaceutically effective amount of a substance inhibiting a compound triggered by the release of TNF-alpha, such as interleukin-1.
 69. A method for inhibiting the action of TNF-alpha for treating nerve root injury in a human by administering a TNF-alpha inhibitor, the method comprising locally administering by subcutaneous administration to the human a therapeutically effective dosage of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is D2E7.
 70. A method for inhibiting the action of TNF-alpha for treating a nerve root injury in a human, the method comprising the step of: (A) locally administering by subcutaneous administration a therapeutically effective dosage to the human of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is a monoclonal antibody that blocks TNF-alpha, which when administered to the human treats the nerve root injury.
 71. A method for the treatment of spinal disorders such as nerve root injury caused by the liberation of TNF-alpha in mammals, including man, the method comprising locally administering by subcutaneous administration a pharmaceutically effective amount of infliximab.
 72. A method for inhibiting the action of TNF-alpha for treating nerve root injury in a human by administering a TNF-alpha inhibitor, the method comprising locally administering by subcutaneous administration to the human a therapeutically effective dosage of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is CDP-870.
 73. A method for inhibiting the action of TNF-alpha for treating nerve root injury in a human by administering a TNF-alpha inhibitor, the method comprising locally administering by subcutaneous administration to the human a therapeutically effective dosage of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is CDP-571.
 74. A method for inhibiting the action of TNF-alpha for treating nerve disorders in a human by administering a TNF-alpha inhibitor comprising administering to the human a therapeutically effective dosage of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is D2E7.
 75. The method of claim 74, wherein the D2E7 is administered subcutaneously or intramuscularly.
 76. The method of claim 74, wherein the D2E7 is administered subcutaneously in a dose of about 0.1 mg/kg to about 50 mg/kg body weight of the human.
 77. The method of claim 74, wherein the D2E7 is administered parenterally, either systemically or locally, in a dose of about 0.1 mg/kg to about 50 mg/kg body weight of the human.
 78. The method of claim 74, wherein the D2E7 is administered intravenously.
 79. The method of claim 74, wherein the D2E7 is administered subcutaneously.
 80. A method for inhibiting the action of TNF-alpha for treating nerve disorders in a human by administering a TNF-alpha inhibitor comprising administering to the human a therapeutically effective dosage of the TNF-alpha inhibitor wherein the TNF-alpha inhibitor is CDP-571 or D2E7.
 81. The method of claim 80, wherein the TNF-alpha inhibitor is administered parenterally.
 82. The method of claim 80, wherein the TNF-alpha inhibitor is administered intramuscularly, intravenously, subcutaneously, or orally.
 83. The method of claim 80, wherein the nerve disorder is nerve root injury.
 84. The method of claim 80, wherein the nerve disorder is a spinal disorder.
 85. The method of claim 80, wherein the nerve disorder involves pain.
 86. The method of claim 80, wherein the TNF-alpha inhibitor is D2E7 and is administered subcutaneously in a dosage of about 0.1 mg/kg to about 50 mg/kg body weight the human.
 87. The method of claim 80, wherein the TNF-alpha inhibitor is D2E7 and is parenterally administered in a dosage of about 0.1 mg/kg to about 50 mg/kg body weight of the human.
 88. The method of claim 80, wherein the TNF-alpha inhibitor is administered parenterally, either systemically or locally.
 89. The method of claim 80, wherein the TNF-alpha inhibitor is administered intravenously.
 90. A method of administering a TNF-alpha inhibitor to a human, the method comprising administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor parenterally by local administration.
 91. The method of claim 90, wherein the human has a nerve disorder.
 92. The method of claim 90, wherein the TNF-alpha inhibitor is selected from the group consisting of: etanercept, pegylated soluble TNF receptor type I, and TBP-1.
 93. The method of claim 90, wherein the TNF-alpha inhibitor comprises CDP-870.
 94. The method of claim 90, wherein the TNF-alpha inhibitor is etanercept administered in a carrier that comprises sterile water.
 95. The method of claim 90, wherein the TNF-alpha inhibitor reduces inflammation or treats a nerve disorder.
 96. A method for treating a nerve disorder in a human, the method comprising administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor parenterally by local administration.
 97. The method of claim 96, wherein the TNF-alpha inhibitor is selected from the group consisting of: etanercept, pegylated soluble TNF receptor type I, and TBP-1.
 98. The method of claim 96, wherein the TNF-alpha inhibitor comprises CDP-870.
 99. The method of claim 96, wherein the TNF-alpha inhibitor is etanercept administered in a carrier that comprises sterile water.
 100. The method of claim 96, wherein the parenteral administration is subcutaneous, intramuscular, or epidural administration.
 101. The method of claim 96, wherein the TNF-alpha inhibitor is etanercept and is administered at a dose of 0.5 mg/kg.
 102. The method of claim 96, wherein the TNF-alpha inhibitor is etanercept and is administered subcutaneously in a dosage of 12.5 mg.
 103. The method of claim 96, wherein the TNF-alpha inhibitor is etanercept and is administered in a dosage of 10-300 mg for oral administration; 25-100 mg for intramuscular administration; 2.5-25 mg for intravenous administration; 0.1-25 mg for intrathecal administration; 0.2-40 mg for administration by inhalation; 10-100 mg for transepidermal administration; 0.1-10 mg for intranasal administration; 5-10 mg for subcutaneous administration; 0.1-25 mg for intracerebroventricular administration; or 1-100 mg for epidural administration.
 104. The method of claim 96, wherein the TNF-alpha inhibitor is administered daily.
 105. A method for treating a nerve disorder in a human, the method comprising administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor parenterally by local administration, wherein the TNF-alpha inhibitor is selected from the group consisting of: etanercept, pegylated soluble TNF receptor type I and TBP-1.
 106. The method of claim 105, wherein the parenteral administration is subcutaneous, intramuscular, or epidural administration.
 107. A method for treating a spinal disorder in a human, the method comprising administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor parenterally by local administration.
 108. A method for treating a spinal disorder in a human, the method comprising administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor parenterally by local administration, wherein the TNF-alpha inhibitor is selected from the group consisting of: etanercept, pegylated soluble TNF receptor type I and TBP-1.
 109. The method of claim 108, wherein the parenteral administration is subcutaneous, intramuscular, or epidural administration.
 110. The method of claim 108, wherein the TNF-alpha inhibitor is etanercept and is administered at a dose of 0.5 mg/kg.
 111. The method of claim 108, wherein the TNF-alpha inhibitor is etanercept and is administered subcutaneously in a dosage of 12.5 mg.
 112. The method of claim 108, wherein the TNF-alpha inhibitor is etanercept and is administered in a dosage of 10-300 mg for oral administration; 25-100 mg for intramuscular administration; 2.5-25 mg for intravenous administration; 0.1-25 mg for intrathecal administration; 0.2-40 mg for administration by inhalation; 10-100 mg for transepidermal administration; 0.1-10 mg for intranasal administration; 5-10 mg for subcutaneous administration; 0.1-25 mg for intracerebroventricular administration; or 1-100 mg for epidural administration.
 113. A method for treating a nerve disorder involving inflammation in a human, the method comprising administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor parenterally by local administration.
 114. The method of claim 13, wherein the TNF-alpha inhibitor is selected from the group consisting of: etanercept, pegylated soluble TNF receptor type 1, and TBP-1.
 115. The method of claim 13, wherein the TNF-alpha inhibitor comprises CDP-870.
 116. The method of claim 13, wherein the TNF-alpha inhibitor is etanercept.
 117. A method of administering a TNF-alpha inhibitor to a human, the method comprising administering to the human a therapeutically effective dosage of a TNF-alpha inhibitor parenterally.
 118. The method of claim 117, wherein the TNF-alpha inhibitor is selected from the group consisting of: etanercept, pegylated soluble TNF receptor type I, and TBP-1.
 119. The method of claim 117, wherein the TNF-alpha inhibitor is etanercept.
 120. The method of claim 117, wherein the TNF-alpha inhibitor is pegylated soluble TNF receptor type I.
 121. The method of claim 117, wherein the TNF-alpha inhibitor is TBP-1.
 122. The method of claim 117, wherein the TNF-alpha inhibitor comprises CDP-870.
 123. The method of claim 117, wherein the TNF-alpha inhibitor is a fusion protein.
 124. A method for delivering D2E7 to a human with a nerve disorder, the method comprising administering the D2E7 parenterally by local administration to the human.
 125. A method for delivering infliximab to a human with a nerve disorder, the method comprising administering the infliximab parenterally by local administration to the human.
 126. A method for delivering an interleukin-1 (IL-1) antagonist to a human with a nerve disorder, the method comprising administering the IL-1 antagonist parenterally by local administration to the human.
 127. The method of claim 126, wherein the IL-1 antagonist is selected from the group consisting of an IL-1 receptor antagonist (anakinra) and a IL-1 type II receptor.
 128. A method for treating spinal cord injury in a human by inhibiting the action of tumor necrosis factor (TNF) through the administration of a TNF antagonist comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, soluble TNF receptor Type I, pegylated soluble TNF receptor Type I (PEGS TNF-R1) and onercept, a recombinant TNF binding protein (r-TBP-1) (Serono); and b) administering said dose parenterally by perispinal administration into the perispinal space without direct intrathecal injection.
 129. A method for treating TNF mediated pain syndromes, being Migraine Headaches, Cluster Headaches, Neuropathic Pain, Fibromyalgia, Post-Herpetic Neuralgia and Reflex Sympathetic Dystrophy (RSD) in a human by inhibiting the action of tumor necrosis factor (TNF) through the administration of a TNF antagonist comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, soluble TNF receptor Type I, pegylated soluble TNF receptor Type I (PEGs TNF-R1) and onercept, a recombinant TNF binding protein (r-TBP-1) (Serono); and b) administering said dose parenterally by perispinal administration into the perispinal space without direct intrathecal injection.
 130. A method for treating TNF mediated back pain syndromes being Lumbar and Cervical Radiculopathy, Low Back Pain and Vertebral Disc Disease in a human by inhibiting the action of tumor necrosis factor (TNF) through the administration of a TNF antagonist comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, soluble TNF receptor Type I, pegylated soluble TNF receptor Type I (PEGs TNF-R1) and onercept, a recombinant TNF binding protein (r-TBP-1) (Serono); and b) administering said dose parenterally by perispinal administration into the perispinal space without direct intrathecal injection.
 131. A method for treating low back pain in a human by inhibiting the action of tumor necrosis factor (TNF) through the administration of a TNF antagonist comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting, of etanercept, and onercept, a recombinant TNF binding protein (r-TBP-1) (Serono); and b) administering said dose parenterally by perispinal administration into the perispinal space without direct intrathecal injection using the interspinous route.
 132. A method for treating vertebral disc disease in a human by inhibiting the action of tumor necrosis factor (TNF) through the administration of a TNF antagonist comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, and onercept, a recombinant TNF binding protein (r-TBP-1) (Serono); and b) administering said dose parenterally by perispinal administration into the perispinal space without direct intrathecal injection using the interspinous route.
 133. A method for treating nerve root inflammation in a human by inhibiting the action of tumor necrosis factor (TNF) through the administration of a TNF antagonist comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, and onercept, a recombinant TNF binding protein (r-TBP-1) (Serono); and b) administering said dose parenterally by perispinal administration into the perispinal space without direct intrathecal injection.
 134. A method for treating nerve root inflammation in a human by inhibiting the action of tumor necrosis factor (TNF) through the administration of a TNF antagonist comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, infliximab, CDP 870 (a humanized monoclonal anti-TNF-alpha antibody fragment), D2E7 (a human anti-TNF mAb), soluble TNF receptor Type I, pegylated soluble TNF receptor Type I (PEGs TNF-R1) and onercept, a recombinant TNF binding protein (r-TBP-1) (Serono); and b) administering said dose parenterally by perispinal administration into the perispinal space without direct intrathecal injection using the interspinous route.
 135. A method for treating low back pain in a human by inhibiting the action of tumor necrosis factor (TNF) through the administration of a TNF antagonist comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist; selected from the group consisting of soluble TNF receptor Type I and pegylated soluble TNF receptor Type I; and b) administering said dose parenterally by perispinal administration into the perispinal space without direct intrathecal injection using the interspinous route.
 136. A method for treating in accordance with claim 130, wherein the step of administering said TNF antagonist is performed through any of the following routes: subcutaneous, intramuscular, interspinous, parenteral, or epidural.
 137. A method for treating Neuropathic Pain in a human by inhibiting the action of tumor necrosis factor (TNF) through the administration of a TNF antagonist comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, and onercept, a recombinant TNF binding protein ((r-TBP-1) Serono); and b) administering said dose parenterally by perispinal administration into the perispinal space without direct intrathecal injection using the interspinous route.
 138. A method of treating neurological conditions in a human by inhibiting the action of TNF, by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of a fusion protein identified as etanercept, infliximab, CDP571 (a humanized monoclonal anti-TNF-alpha IgG4 antibody), CDP 870 (a humanized monoclonal anti-TNF-alpha antibody fragment), D2E7 (a human anti-TNF mAb), soluble TNF receptor Type I, and pegylated soluble TNF receptor Type I (PEGs TNF-R1) for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose either intralesionally or perilesionally.
 139. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said TNF antagonist is performed through any of the following routes: subcutaneous, intrathecal, intramuscular, intranasal, transepidermal, parenteral, transepithelial, or epidural.
 140. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said dosage level is for treating nerve root injury caused by a herniated nucleus pulposus.
 141. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said dosage level is for treating acute spinal cord injury.
 142. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said dosage level is for treating spinal cord compression.
 143. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said dosage level is for treating spinal stenosis.
 144. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said dosage level is for treating localized disorders of muscle, including muscle spasm, muscle tear, muscle injury, muscle strain, or muscle sprain.
 145. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said TNF antagonist is performed subcutaneously in said human wherein said dosage level is in the range of 1 mg to 300 mg per dose.
 146. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said TNF antagonist in the form of etanercept is performed intramuscularly in said human wherein said dosage level is in the range of 1 mg to 100 mg.
 147. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said TNF antagonist in the form of etanercept is performed subcutaneously in said human wherein said dosage level is in the range of 1 mg to 100 mg.
 148. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said TNF antagonist in the form of etanercept is performed subcutaneously in said human wherein said dosage level is in the range of 10 mg to 25 mg.
 149. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said TNF antagonist in the form of D2E7 is performed subcutaneously in said human, wherein said dosage level is in the range of 1 mg to 100 mg.
 150. A method for inhibiting the action of TNF in accordance with claim 138, wherein the step of administering said TNF antagonist in the form of D2E7 is performed subcutaneously in said human, wherein said dosage level is in the range of 10 mg to 40 mg.
 151. A method of treating or preventing nerve root injury in a human by inhibiting the action of TNF, by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, infliximab, CDP571 (a humanized monoclonal anti-TNF-alpha IgG4 antibody), CDP 870 (a humanized monoclonal anti-TNF-alpha antibody fragment), D2E7 (a human anti-TNF mAb), soluble TNF receptor Type I, and pegylated soluble TNF receptor Type I (PEGs TNF-R1) for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose either intralesionally or perilesionally.
 152. A method of treating neurological conditions in a human by inhibiting the action of TNF, by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human, comprising the step of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of a fusion protein identified as etanercept, infliximab, CDP571 (a humanized monoclonal anti-TNF-alpha IgG4 antibody), CDP 870 (a humanized monoclonal anti-TNF-alpha antibody fragment), D2E7 (a human anti-TNF mAb), soluble TNF receptor Type I, and pegylated soluble TNF receptor Type I (PEGs TNF-R1) for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human.
 153. A method of treating or preventing nerve root injury in a human by inhibiting the action of TNF, by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of a soluble TNF receptor Type I for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose perilesionally by subcutaneous administration in the lumbar area (for lumbar or sacral nerve roots) or in the cervical area (for cervical nerve roots).
 154. A method of treating or preventing nerve root injury in a human by inhibiting the action of TNF, by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of a pegylated soluble TNF receptor Type I for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose perilesionally by subcutaneous administration in the lumbar area (for lumbar or sacral nerve roots) or in the cervical area (for cervical nerve roots).
 155. A method of treating or preventing nerve root injury in a human by inhibiting the action of TNF, by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of a molecule containing at least one soluble TNF receptor for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose perilesionally by subcutaneous administration in the lumbar area (for lumbar or sacral nerve roots) or in the cervical area (for cervical nerve roots).
 156. A method of treating or preventing nerve root injury in a human by inhibiting the action of TNF, by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist consisting of a molecule which contains a fragment of any of the molecules selected from the group consisting of etanercept, infliximab, CDP571 (a humanized monoclonal anti-TNF-alpha IgG4 antibody), CDP 870 (a humanized monoclonal anti-TNF-alpha antibody fragment), D2E7 (a human anti-TNF mAb), soluble TNF receptor Type I, and pegylated soluble TNF receptor Type I (PEGs TNF-R1) for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose either intralesionally or perilesionally.
 157. A method of treating or preventing nerve root injury caused by a herniated nucleus pulposus in a human by inhibiting the action of TNF, by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, infliximab, CDP571 (a humanized monoclonal anti-TNF-alpha IgG4 antibody), CDP 870 (a humanized monoclonal anti-TNF-alpha antibody fragment), D2E7 (a human anti-TNF mAb), a molecule containing a soluble TNF receptor, a molecule containing multiple soluble TNF receptors, and a molecule which contains a fragment of any of the above molecules for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose either intralesionally or perilesionally.
 158. A method of treating a pathologic condition in a human by inhibiting the action of TNF, the pathologic condition being spinal cord compression due to metastatic cancer, by administering a TNF antagonist, defined as any of the following types of molecules directed against said TNF: a monoclonal antibody; a monoclonal antibody fragment; a TNF binding protein; or a fusion protein; comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist; and b) administering said dose either intralesionally or perilesionally.
 159. A method of treating a pathologic condition in a human by inhibiting the action of TNF, the pathologic condition being a neurological disease or disorder which is caused or exacerbated by the action of said TNF, by administering a TNF antagonist, defined as any of the following types of molecules directed against said TNF: a monoclonal antibody; a monoclonal antibody fragment; a TNF binding protein; or a fusion protein; comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist; and b) administering said dose either intralesionally or perilesionally.
 160. A method for inhibiting the action of TNF for treating neurological conditions in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of a fusion protein identified as etanercept, infliximab, CDP571 (a humanized monoclonal anti-TNF-alpha IgG4 antibody), CDP 870 (a humanized monoclonal anti-TNF-alpha antibody fragment) and D2E7 (a human anti-TNF mAb) for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose either intralesionally or perilesionally.
 161. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said TNF antagonist is performed through any of the following routes: subcutaneous, intrathecal, intramuscular, intranasal, transepidermal, parenteral, transconjunctival, or epidural.
 162. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said dosage level is for treating nerve root injury caused by a herniated nucleus pulposus.
 163. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said dosage level is for treating acute spinal cord injury.
 164. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said dosage level is for treating spinal cord compression.
 165. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said dosage level is for treating spinal stenosis.
 166. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said dosage level is for treating localized disorders of muscle, including muscle spasm, muscle tear, muscle injury, muscle strain, or muscle sprain.
 167. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said TNF antagonist is performed subcutaneously in said human wherein said dosage level is in the range of 1 mg to 300 mg per dose.
 168. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said TNF antagonist in the form of etanercept is performed intramuscularly in said human wherein said dosage level is in the range of 1 mg to 100 mg.
 169. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said TNF antagonist in the form of etanercept is performed subcutaneously in said human wherein said dosage level is in the range of 1 mg to 100 mg.
 170. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said TNF antagonist in the form of etanercept is performed subcutaneously in said human wherein said dosage level is in the range of 10 mg to 25 mg.
 171. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said TNF antagonist in the form of D2E7 is performed subcutaneously in said human, wherein said dosage level is in the range of 1 mg to 100 mg.
 172. A method for inhibiting the action of TNF in accordance with claim 160, wherein the step of administering said TNF antagonist in the form of D2E7 is performed subcutaneously in said human, wherein said dosage level is in the range of 10 mg to 40 mg.
 173. A method for inhibiting the action of TNF for treating or preventing nerve root injury in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of etanercept, for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose either intralesionally or perilesionally.
 174. A method for inhibiting the action of TNF for treating or preventing nerve root injury in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of etanercept, for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose subcutaneously to the area anatomically adjacent to the site of disc herniation.
 175. A method for inhibiting the action of TNF in accordance with claim 174, wherein the step of administering said dosage level is for treating nerve root injury due to a herniated nucleus pulposus, wherein the dosage level is between 1 mg and 100 mg.
 176. A method for inhibiting the action of TNF for treating or preventing nerve root injury in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, infliximab, CDP571 (a humanized monoclonal anti-TNF-alpha IgG4 antibody), CDP 870 (a humanized monoclonal anti-TNF-alpha antibody fragment) and D2E7 (a human anti-TNF mAb), for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose either intralesionally or perilesionally.
 177. A method for inhibiting the action of interleukin (IL) for treating neurological disorders in a human by administering an IL Blocker for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human, comprising the step of: a) administering a therapeutically effective dosage level to said human of said IL Blocker for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose either intralesionally or perilesionally.
 178. A method for inhibiting the action of IL in accordance with claim 177, wherein said IL Blocker is selected from the group consisting of IL-1 RA, IL-IR type II, a monoclonal antibody to IL-1, soluble receptors to IL-1, soluble receptors to IL-1 fused to an Fc immunoglobulin fragment, a monoclonal antibody to IL-6, and a monoclonal antibody to IL-8.
 179. A method for inhibiting the action of IL in accordance with claim 178, wherein the step of administering said IL Blocker is performed through local subcutaneous administration for treating nerve root injury caused by intervertebral disc herniation.
 180. A method for inhibiting the action of IL in accordance with claim 178, wherein the step of administering said IL Blocker is performed through local subcutaneous administration for treating acute spinal cord injury.
 181. A method for inhibiting the action of TNF for treating or preventing nerve root injury in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of etanercept, for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose perilesionally by subcutaneous administration in the lumbar area (for lumbar or sacral nerve roots) or in the cervical area (for cervical nerve roots).
 182. A method for inhibiting the action of TNF for treating or preventing nerve root injury in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of D2E7, for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose perilesionally by subcutaneous administration in the lumbar area (for lumbar or sacral nerve roots) or in the cervical area (for cervical nerve roots).
 183. A method for inhibiting the action of TNF for treating or preventing nerve root injury in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of infliximab, for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose perilesionally by subcutaneous administration in the lumbar area (for lumbar or sacral nerve roots) or in the cervical area (for cervical nerve roots).
 184. A method for inhibiting the action of TNF for treating or preventing nerve root injury in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response to affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of CDP 870, for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose perilesionally by subcutaneous administration in the lumbar area (for lumbar or sacral nerve roots) or in the cervical area (for cervical nerve roots).
 185. A method for inhibiting the action of TNF for treating or preventing nerve root injury in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said nerve root of said human, comprising the steps of: a) administering a therapeutically effective dosage level to said human of CDP 571, for reducing the inflammation of said nerve root of said human, or for modulating the immune response affecting neuronal tissue of said human; and b) administering said dose perilesionally by subcutaneous administration in the lumbar area (for lumbar or sacral nerve roots) or in the cervical area (for cervical nerve roots).
 186. A method for inhibiting the action of TNF for treating neurological conditions in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human, comprising the step of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of a fusion protein identified as etanercept, infliximab, CDP571 (a humanized monoclonal anti-TNF-alpha IgG4 antibody), CDP 870 (a humanized monoclonal anti-TNF-alpha antibody fragment) and D2E7 (a human anti-TNF mAb) for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human.
 187. A method for inhibiting the action of TNF for treating neurological conditions in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue or the neuromuscular junction of said human, or for modulating the immune response affecting neuronal tissue or the neuromuscular junction of said human, comprising the step of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, infliximab, and D2E7 (a human anti-TNF mAb from Knoll Pharmaceuticals) for reducing the inflammation of neuronal tissue or the neuromuscular junction of said human, or for modulating the immune response affecting neuronal tissue or the neuromuscular junction of said human.
 188. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist is performed through any of the following routes: subcutaneous, intravenous, intrathecal, intramuscular, parenteral, or intracerebroventricular.
 189. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said dosage level is for treating neurological disorders associated with HIV, including HIV Dementia, HIV-associated Myelopathy, and HIV-associated Peripheral Neuropathy.
 190. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said dosage level is for treating HTLV-1 Myelopathy.
 191. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said dosage level is for treating Reye's Syndrome.
 192. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said dosage level is for treating Meniere's Disease.
 193. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said dosage level is for treating neurological disorders associated with Poliomyelitis, including acute Poliomyelitis and postpolio syndrome.
 194. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist in the form of etanercept is performed subcutaneously in said human wherein said dosage level is in the range of 5 mg to 50 mg for acute or chronic regimens.
 195. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist in the form of D2E7 is performed subcutaneously in said human wherein said dosage level is in the range of 20 mg to 100 mg for acute or chronic regimens.
 196. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist in the form of infliximab is performed subcutaneously in said human wherein said dosage level is a therapeutically effective amount.
 197. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist in the form of etanercept is performed intramuscularly in said human wherein said dosage level is in the range of 25 mg to 100 mg.
 198. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist in the form of infliximab is performed intravenously in said human wherein said dosage level is in the range of 2.5 mg/kg to 20 mg/kg.
 199. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist in the form of etanercept is performed intrathecally in said human wherein said dosage level is in the range of 0.1 mg to 25 mg administered from once a day to once every 3 months.
 200. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist in the form of infliximab is performed intrathecally in said human wherein said dosage level is in the range of 0.1 mg/kg to 5 mg/kg administered from once a week to once every 3 months.
 201. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist in the form of D2E7 is performed intrathecally in said human wherein said dosage level is in the range of 0.1 mg to 25 mg administered from once a week to once every 3 months.
 202. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist is performed intravenously in said human wherein said dosage level is a therapeutically effective amount.
 203. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist in the form of etanercept is performed intracerebroventricularly in said human wherein said dosage level is in the range of 0.1 mg to 25 mg administered from once a day to once a month.
 204. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist in the form of infliximab is performed intracerebroventricularly in said human wherein said dosage level is in the range of 0.1 mg/kg to 5 mg/kg administered from once a week to once every 3 months.
 205. A method for inhibiting the action of TNF in accordance with claim 187, wherein the step of administering said TNF antagonist in the form of D2E7 is performed intracerebroventricularly in said human wherein said dosage level is in the range of 0.1 mg to 25 mg administered from once a week to once every 3 months.
 206. A method for inhibiting the action of TNF for treating neurological effects of Epilepsy in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue or the neuromuscular junction of said human, or for modulating the immune response affecting neuronal tissue or the neuromuscular junction of said human, comprising the step of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, infliximab, and D2E7 (a human anti-TNF mAb from Knoll Pharmaceuticals) for reducing the inflammation of neuronal tissue or the neuromuscular junction of said human, or for modulating the immune response affecting neuronal tissue or the neuromuscular junction of said human.
 207. A method for inhibiting the action of TNF in accordance with claim 206, wherein the step of administering said TNF antagonist in the form of etanercept is performed subcutaneously in said human wherein said dosage level is in the range of 5 mg to 50 mg for acute or chronic regimens.
 208. A method for inhibiting the action of TNF in accordance with claim 206, wherein the step of administering said TNF antagonist in the form of D2E7 is performed subcutaneously in said human wherein said dosage level is in the range of 20 mg to 100 mg for acute or chronic regimens.
 209. A method for inhibiting the action of TNF in accordance with claim 206, wherein the step of administering said TNF antagonist is performed subcutaneously in said human wherein said dosage level is a therapeutically effective amount.
 210. A method for inhibiting the action of TNF in accordance with claim 206, wherein the step of administering said TNF antagonist in the form of D2E7 is performed intravenously in said human wherein said dosage level is a therapeutically effective amount.
 211. A method for inhibiting the action of TNF in accordance with claim 206, wherein the step of administering said TNF antagonist in the form of infliximab is performed intravenously in said human wherein said dosage level is in the range of 2.5 mg/kg to 20 mg/kg.
 212. A method for inhibiting the action of TNF in accordance with claim 206, wherein the step of administering said TNF antagonist is performed intravenously in said human wherein said dosage level is a therapeutically effective amount.
 213. A method for inhibiting the action of TNF for treating neurological conditions in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue or the neuromuscular junction of said human, or for modulating the immune response affecting neuronal tissue or the neuromuscular junction of said human, comprising the step of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept, infliximab, pegylated soluble TNF receptor Type I (PEGsTNF-R1), CDP571 (a humanized monoclonal anti-TNF-alpha antibody), and D2E7 (a human anti-TNF mAb) for reducing the inflammation of neuronal tissue or the neuromuscular junction of said human, or for modulating the immune response affecting neuronal tissue or the neuromuscular junction of said human.
 214. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist is performed through any of the following routes: subcutaneous, intravenous, intrathecal, intramuscular, intranasal, oral, transepidermal, parenteral, by inhalation, or intracerebroventricular.
 215. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said dosage level is for treating neurodegenerative diseases including Alzheimer's disease, Huntington's disease and Creutzfeld-Jakob disease.
 216. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said dosage level is for treating neurological traumas and injuries, and for treating neurological diseases and disorders.
 217. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said dosage level is for treating acute spinal cord or brain injury.
 218. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said dosage level is for treating chronic pain syndrome due to metastatic tumor.
 219. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said dosage level is for treating peripheral neuropathies, including diabetic neuropathy.
 220. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said dosage level is for treating central nervous system lesions.
 221. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist is performed subcutaneously in said human wherein said dosage level is in the range of 5 mg to 50 mg for acute or chronic regimens.
 222. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist is performed intranasally in said human wherein said dosage level is in the range of 0.1 mg to 10 mg for acute or chronic regimens.
 223. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist in the form of etanercept is performed intramuscularly in said human wherein said dosage level is in the range of 25 mg to 100 mg.
 224. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist in the form of infliximab is performed intravenously in said human wherein said dosage level is in the range of 2.5 mg/kg to 20 mg/kg.
 225. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist in the form of etanercept is performed subcutaneously in said human wherein said dosage level is in the range of 5 mg to 50 mg.
 226. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist in the form of etanercept is performed intrathecally in said human wherein said dosage level is in the range of 0.1 mg to 25 mg administered from once a day to once every three months.
 227. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist in the form of infliximab is performed intrathecally in said human wherein said dosage level is in the range of 0.1 mg/kg to 5 mg/kg administered from once a week to once every three months.
 228. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist is performed transepidermally in said human wherein said dosage level is in the range of 10 mg to 100 mg.
 229. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist is performed by inhaling in said human wherein said dosage level is in the range of 0.2 mg to 40 mg.
 230. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist is performed intravenously in said human wherein said dosage level is a therapeutically effective amount.
 231. A method for inhibiting the action of TNF in accordance with claim 213 wherein the step of administering said TNF antagonist in the form of etanercept is performed intracerebroventricularly in said human wherein said dosage level is in the range of 0.1 mg to 25 mg administered once a day to once a month.
 232. A method for inhibiting the action of TNF in accordance with claim 213, wherein the step of administering said TNF antagonist in the form of infliximab is performed intracerebroventricularly in said human wherein said dosage level is in the range of 0.1 mg/kg to 5 mg/kg administered once a week to once every 3 months.
 233. A method for inhibiting the action of TNF for treating neurological conditions in a human by administering a TNF antagonist for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human, comprising the step of: a) administering a therapeutically effective dosage level to said human of said TNF antagonist selected from the group consisting of etanercept and infliximab for reducing the inflammation of neuronal tissue of said human, or for modulating the immune response affecting neuronal tissue of said human.
 234. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said TNF antagonist is performed subcutaneously, intravenously, intrathecally, or intramuscularly.
 235. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said dosage level is for treating neurological diseases and disorders.
 236. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said dosage level is for treating neurological traumas and injuries.
 237. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said dosage level is for treating acute spinal cord injury.
 238. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said dosage level is for treating herniated discs.
 239. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said dosage level is for treating spinal cord compression.
 240. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said dosage level is for treating central nervous system lesions.
 241. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said etanercept is performed subcutaneously in said human wherein said dosage level is in the range of 10 mg to 50 mg for acute or chronic regimens.
 242. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said etanercept is performed subcutaneously in said human wherein said dosage level is 25 mg for acute or chronic regimens.
 243. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said etanercept is performed intramuscularly in said human wherein said dosage level is in the range of 25 mg to 100 mg.
 244. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said etanercept is performed intravenously in said human wherein said dosage level produces a serum concentration in the range of 0.5 mg/Ml to 50 mg/ml.
 245. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said etanercept is performed intravenously by infusion in said human wherein said dosage level produces a serum concentration of 10 mg/ml.
 246. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said etanercept is performed intrathecally in said human wherein said dosage level is in the range of 1 mg to 50 mg.
 247. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said infliximab is performed subcutaneously in said human wherein said dosage level is in the range of 0.1 mg/kg to 2.5 mg/kg.
 248. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said infliximab is performed intramuscularly in said human wherein said dosage level is in the range of 0.1 mg/kg to 2.5 mg/kg for acute or chronic regimens.
 249. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said infliximab is performed intravenously in said human wherein said dosage level is in the range of 2.5 mg/kg to 20 mg/kg.
 250. A method for inhibiting the action of TNF in accordance with claim 233, wherein the step of administering said infliximab is performed intrathecally in said human wherein said dosage level is in the range of 0.05 mg/kg to 1 mg/kg.
 251. A method for delivering a TNF antagonist to the brain of a human, comprising administering a TNF antagonist parenterally into the perispinal space of said human without direct intrathecal injection.
 252. The method of claim 251 wherein said administered TNF antagonist travels via the human's vertebral venous system to the brain.
 253. The method of claim 251, wherein said human has a neurological disorder, and said neurological disorder is selected from the group consisting of mild cognitive impairment, possible Alzheimer's disease, probable Alzheimer's disease, Alzheimer's disease, senile dementia/Alzheimer's disease, idiopathic dementia or dementia of unknown cause, dementia with Lewy bodies, Picks disease and other frontotemporal dementias, traumatic brain injury, AIDS (HIV) dementia, and vascular dementia.
 254. The method of claim 251, wherein the TNF antagonist is selected from the group consisting of etanercept, pegylated soluble TNF receptor type 1, and onercept.
 255. The method of claim 251, wherein the TNF antagonist comprises CDP
 870. 256. The method of claim 251, wherein said TNF antagonist is etanercept administered in a dosage which comprises sterile water without a preservative.
 257. The method of claim 251 wherein said TNF antagonist is delivered to the brain via retrograde flow of the TNF antagonist in the vertebral venous system of the human.
 258. The method of claim 257 wherein said human has dementia.
 259. The method of claim 251 wherein said TNF antagonist is delivered to the brain of the human to perform one or more of the following: reduce inflammation, improve cognition or treat dementia.
 260. A method for treating a neurological disorder in a human whose disorder is characterized by an excess of TNF, comprising administering an amount of a TNF antagonist parenterally into the perispinal space of said human without direct intrathecal injection, wherein said administered TNF antagonist travels via the human's vertebral venous system to the brain in an amount effective to treat the neurological disorder.
 261. The method of claim 260, wherein said neurological disorder is selected from the group consisting of mild cognitive impairment, possible Alzheimer's disease, probable Alzheimer's disease, Alzheimer's disease, senile dementia/Alzheimer's disease, idiopathic dementia or dementia of unknown cause, dementia with Lewy bodies, Picks disease and other frontotemporal dementias, traumatic brain injury, AIDS (HIV) dementia, and vascular dementia.
 262. The method of claim 260, wherein the TNF antagonist is selected from the group consisting of etanercept, pegylated soluble TNF receptor type 1, and onercept.
 263. The method of claim 260, wherein said TNF antagonist comprises CDP
 870. 264. The method of claim 260, wherein said antagonist is etanercept administered in a dosage which comprises sterile water without a preservative.
 265. The method of claim 260, wherein said perispinal administration is performed by subcutaneous, intramuscular, interspinous, epidural, or peridural administration.
 266. A method for treating a human with Alzheimer's disease, comprising: perispinally administering an amount of a TNF antagonist to the human without direct intrathecal injection, and wherein said perispinal administration results in retrograde delivery of the TNF antagonist to the brain via the vertebral venous system in an amount of TNF antagonist to the brain effective to treat Alzheimer's disease.
 267. The method of claim 266, wherein said TNF antagonist is etanercept and said etanercept is administered in a dosage of no greater than 100 mg.
 268. The method of claim 266, wherein said TNF antagonist is etanercept and said etanercept is administered in a dosage of no greater than 50 mg.
 269. The method of claim 266, further comprising administering said TNF antagonist in multiple dosages, wherein said dosages are administered on a weekly basis.
 270. The method of claim 266, further comprising administering said TNF antagonist on a daily basis.
 271. A method for treating a human with a dementia related disease, comprising: perispinally administering an amount of a TNF antagonist selected from the group consisting of etanercept, pegylated soluble TNF receptor type 1 and onercept; wherein said administered TNF antagonist travels via the human's vertebral venous system to the brain in an effective amount to treat the dementia related disease.
 272. The method of claim 271, wherein said dementia related disease is selected from the group consisting of senile dementia, idiopathic dementia, dementia with Lewy bodies, Picks disease, AIDS (HIV) dementia and vascular dementia.
 273. The method of claim 271, wherein said perispinal administration is selected from the group consisting of parenteral, subcutaneous, intramuscular, interspinous, epidural or peridural, and does not include direct intrathecal administration.
 274. The method of claim 271 further comprising administering said TNF antagonist with an indwelling catheter.
 275. The method of claim 274, wherein said indwelling catheter delivers said TNF antagonist to the interspinous space.
 276. A method to improve cognitive function in a human with a systemic or localized non-neurological primary condition which is associated with increased TNF, comprising: administering an amount of a TNF antagonist to the human, wherein said TNF antagonist is parenterally administered into the perispinal space without direct intrathecal injection; and positioning the human's head in a position to facilitate retrograde flow to the brain to deliver an effective amount of the TNF antagonist to the brain via the human's vertebral venous system.
 277. The method of claim 276, wherein said primary condition is selected from the group consisting of rheumatoid arthritis, juvenile rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, cancer cachexia and cancer metastatic to the spine.
 278. A method for improvement of cognitive performance in an individual, wherein said individual does not suffer from a brain injury or other neurological disorder, comprising: parenterally delivering an amount of a TNF antagonist to the brain via the vertebral venous system of the individual, wherein said TNF antagonist is selected from the group consisting of etanercept, pegylated soluble TNF receptor type 1 and onercept; and positioning individual to facilitate retrograde flow of the TNF antagonist to the brain of the individual for enhanced cognitive performance.
 279. The method of claim 278, wherein said TNF antagonist is selected from the group consisting of subcutaneous, intramuscular, interspinous, epidural or peridural administration.
 280. The method of claim 278, wherein said amount of TNF antagonist is administered in an amount no greater than 100 mg.
 281. A method for reducing neurological inflammation in a human, comprising: administering a TNF antagonist to the human experiencing neurological inflammation, wherein said TNF antagonist is administered perispinally without direct intrathecal injection; and positioning the human to deliver an effective amount of the TNF antagonist to the human's brain via the vertebral venous system.
 282. The method of claim 281, wherein said TNF antagonist is selected from the group consisting of etanercept, pegylated soluble TNF receptor type 1, and onercept.
 283. The method of claim 281, wherein said TNF antagonist comprises CDP
 870. 284. The method of claim 281, wherein said TNF antagonist is etanercept.
 285. A method for delivering a TNF antagonist to the brain of a human, comprising parenterally delivering a TNF antagonist to the brain via the vertebral venous system of said human.
 286. The method of claim 285, wherein said TNF antagonist is delivered by administering the TNF antagonist to the perispinal space without direct intrathecal injection.
 287. The method of claim 285, wherein said TNF antagonist is selected from the group consisting of etanercept, pegylated soluble TNF receptor type 1 and onercept.
 288. The method of claim 285, wherein said TNF antagonist is etanercept.
 289. The method of claim 285, wherein said TNF antagonist is pegylated soluble TNF receptor type
 1. 290. The method of claim 285, wherein said TNF antagonist is onercept.
 291. The method of claim 285, wherein the TNF antagonist comprises CDP
 870. 292. The method of claim 285, wherein said TNF antagonist is a fusion protein.
 293. A method for delivering D2E7 to a human with Alzheimer's Disease, comprising administering said D2E7 parenterally into the perispinal area of said human without direct intrathecal injection.
 294. A method for delivering D2E7 to a human with dementia, comprising administering said D2E7 parenterally into the perispinal area of said human without direct intrathecal injection.
 295. A method for delivering infliximab to a human with dementia, comprising administering said infliximab parenterally into the perispinal area of said human without direct intrathecal injection.
 296. A method for delivering infliximab to a human with Alzheimer's Disease, comprising administering said infliximab parenterally into the perispinal area of said human without direct intrathecal injection.
 297. A method for delivering an interleukin-1 (IL-1) antagonist to a human with Alzheimer's Disease, comprising administering said IL-1 antagonist parenterally into the perispinal area of said human without direct intrathecal injection.
 298. The method of claim 297, wherein said IL-1 antagonist is selected from the group consisting of an IL-1 receptor antagonist (Kineret®, Amgen); IL-1 Receptor type 2 (Amgen); AMG719 (Amgen) and IL-1 Trap (Regeneron).
 299. A method for delivering an interleukin-1 (IL-1) antagonist to a human with dementia, comprising administering said IL-1 antagonist parenterally into the perispinal area of said human without direct intrathecal injection.
 300. The method of claim 299, wherein said IL-1 antagonist is selected from the group consisting of an IL-1 receptor antagonist (Kineret® type 2 (Amgen); AMG719 (Amgen) and IL-1 Trap (Regeneron). 